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The Office of the Ombudsman works independently as an intermediary to provide individuals with a confidential avenue to address complaints and resolve issues at the lowest possible level. The Office proposes policy and procedural changes when systemic issues are identified.
This is what they are supposed to do as they claim, yet I have been going through the ringer with this office and the Medi-Cal offices here in San Francisco and in Orange County. Also with Cal*Optima in Orange County which is a state Insurance network like Healthy San Francisco and Anthem Blue Cross of California.
Because the county of Orange is larger than SF county there are other plans offered to eligible low-income participants in the county. The reason I know so much about OC is because my family and I lived there 9 years before moving here to San Francisco almost two years ago.
When we moved I did everything I was suppose to do. Notifying the proper authorities of our move so that things would move as smoothly as possible even though life here hasn't been smooth. It's been a bumpy journey.
Everything was going fine as far as our insurance is concerned that is until my son's doctors office called to inform me that my son was NO LONGER covered under their group. To top that off not only was he not covered he was not even in their system as of January 1, 2013. What do you mean not covered? I asked
He can come to the appointment but you'll have to pay for services rendered, she informed me.
I went from disbelief to shock and from shock to anger at what was unfolding before me. After calming myself down I asked her who I needed to call to get this straightened out, she told me to contact the local Medi-Cal office which I did and the lady confirmed what the nurse told me, she said that his case had been transferred to Orange County where he had just moved.
Now I'm on the phone with this lady clearly in San Francisco on the campus of City College in between classes and my son is clearly sitting in a classroom at Galileo High School here in San Francisco so how in the hell are we re-located to Orange County when we are physically in San Francisco?
Here I am having to prove we are where we say we are, but who ever did this is not having to prove where they claim we are. So like the other person I spoke too, I asked her the same question who do I need to contact? She gave a number in Orange County for Social Services. I call them and explain the situation at hand and am told "we do not have this child in our system anymore". "His file was transferred in August of 2011 to San Francisco county" is what she told me and instructed me to contact the real culprit in this "cat and mouse" ordeal....The Office of the Obudsman.
So I call them and after explaining what had happened, instantly Alicia was very very rude( she was the person I spoke too). She informed me that I had not transferred his case and therefore they had no choice but to act. She and I went back and forth for 10 minutes before she said she would get right on it. She told me to give her 24 hours and if I hadn't heard back from her within that time frame to call back. Needless to say she didn't and I called back and spoke to another rude person that refused to give me her named but gave me her employee number-PCBJ. What she said next really pissed me off after having to wait on hold for 40 minutes and 35 seconds and made me late for my class (which I'm never late), she said "nobody works in this office by the name of Alicia and there is no record that you called much less spoke to anyone". So needless to say she and I went back and forth for a short time period before she informed me that Cal*Optima had not properly moved my son's case to SF and that's where the problem was. To put the cherry on top of this sundae she tells me "every service that has been rendered to my son and every pill he has swallowed I will be sent a bill for because he isn't covered in the county of San Francisco".
I went from pissed to panic!
After my class was over and while riding on the 43 Masonic bus I called Cal*Optima and explained the situation and they informed me that they did get his case back and had assigned him a group and doctor because that's what they had been told by guess who? The Office of the Obudsman.
Yes you read it right...The Office of the Obudsman. So I asked her "what do I need to do in order to straighten this out?" " You have to call the state office back and inform them that you've spoken to me and that you want your sons case transferred back to San Francisco county and give them your address there in the city and that should take care of the problem" oh yeah and tell them you need an emergency re-entrance into Anthem Blue Cross so that your son doesn't miss anymore appointments, she said. So I did, but this time I spoke to a gentleman that informed me that no one had made a note of me calling but that he would get right on it....that was two weeks ago and still nothing.
My son has missed an appointment with his PCP(Primary Care Provider), his Allergist (where he was suppose to begin his allergy shots) and his Dermatologist( he has Eczema) all because The Office of the Obudsman decided to jerk around with somsome body'salth. My son has a medical disability and you can't play with that.
If their doing this to our family think how many more families are going through this and not know ing what to do or who to call for that matter?
If you have experienced the same thing or worse it's time to voice it, be heard and let's change how we as poor peoples are being treated. This office needs to work on their people skills, they simply do not know how to talk to people, but I bet they'd know if it was them trying to get to the bottom of a situation.
The moral is:Watch how you treat people because you never know what's gonna happen when your time comes around and you need somebody to be compassionate to you, you'll need that helping hand...Karma is a bleeeep!
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