Hi, I have a cleint who attempted to switch MCOs from Neighborhood to MassHealth PCC. Neighborhood does not have a specialist that fits his needs within the greater area. The member was told that he needed an existing referral to a specialist for the request to be submitted. Unfortunately, in our area, you cannot secure […]
Hi All, Thought I would share my thoughts on something that came up. We had a dual eligible MassHealth/Medicare member who had the option to enroll in health insurance through an employer. They just turned 65 and happened to also receive a Confirmed Access to ESI Letter from MassHealth (the one requesting you jump onto […]
Hi, I came across an issue that I am sure others have experienced too. A consumer came to me with their parent because they were determined not eligible. I went through their application looking at the various reasons they could have received that determination. Nothing stood out as incorrect. I submitted the application and the […]
Hi, I am still experiencing issues with Health Connector CSR when updating applications. Now that we have the assister portal, it is much easier to make updates on our own. But I am still cleaning up after HC CSR mistakes. This time a Connector Care household went through CSR twice to update income and confirm […]
Hi, I have a member looking to switch providers (doctors, not insurance carriers/MCO/PCC) and it needs to happen quickly due to medical need. Her current provider declined to show up to two scheduled appointments and now she would like to find another that is more responsive. She called MassHealth to change PCPs, but was told […]
Hi, UMass Disability Evaluation Services uses fax number 774-455-8156. A fax I sent went to Standby mode indicating it was having difficulty. I decided to follow up with a phone call. Turns out DES has not received any faxes from Yesterday or Today. If you have sent a fax to UMass DES during this time […]
Hi, One of the troubles I have with the new fixed enrollment process is that the member has to choose the reason they are looking to switch plans. The reasons provided are not fully defined and the process is decided on a case-by-case basis, taking more than a few days. The only plans that provide […]
Hi, I’ve had 2 MCO switches after the MCO Enrollment Period that are being escalated. The individuals are on an MCO that does not have specialists within the plans under a driving distance of 45 minutes. Under MassHealth PCC or HNE Be Healthy they are able to get care within the county. The only Care […]
Hi, Have others experienced a long wait time when calling the MassHealth Assister Line for MCO switch? It took 12 minutes this morning to get through. This happened at 9:10am this morning. Thanks, Peter
Hi, I have a MassHealth CommonHealth client with Medicare Part A, and is eligible to enroll in Part B (Medical) starting July 2017. They lost their Medicare Part B (Medical) due to non-payment in 2014. The client wants to know the best course of action to receive a full health coverage type. We spoke with […]