PCAs NOT Getting Paid Until…
Since Nick’s insurance changed from Commonwealth Care Alliance to MassHealth on December 1, 2024, there is no current approval for PCA hours starting on December 1st to be paid for by MassHealth because there hasn’t been an evaluation for hours submitted to MassHealth, and obviously no hours approved without an evaluation being submitted yet.
I knew the new evaluation needed to be done, and I called his old skills trainer (female) last month warning her that his insurance was changing on December 1st. She said that they would receive notification from his insurance and they would start the process of getting an extension on the hours that were approved by his old insurance (paid by new insurance) and scheduling a new evaluation.
I also called last week and left a voice mail to the skills trainer on call. I never got a call back.
In the mean time, I’ve been dealing with trying to get his crazy expensive anti-rejection medications covered by his new insurance, as he takes an expired one until it get approved no less.
This morning, Donna called to say that the timesheets that Steve and I submitted on Sunday for the past two weeks of work have an issue. Tempus Unlimited called her and said that they are waiting for MassHealth approval. Damn!
I called Tri-Valley and spoke with his NEW skills trainer, Lewis Lopez, 978-907-5781. He and his supervisor will be submitting a request to his new insurance, MassHealth, for a 3 month extension of the currently approved PCA hours. This takes from 15-30 days. He said it never takes 30 days.
DON’T submit timesheets until that extension approval comes through.
Once that approval comes through, timesheets can be submitted and PCAs will then get back pay to December 1st.
In the mean time, we’ll be scheduling a new evaluation with the nurse from Tri-Valley to evaluate him for the number of PCA hours he can get, paid by MassHealth. These new hours should be approved before the 3 month extension comes to an end to ensure there is no gap in PCAs working/getting paid.