by Edna Wallace, LMFT

You ring.
“Welcome to Spectrum Healthcare, where we meet all your healthcare needs! You are a valued customer, so we will get to your call just as soon as we can!”
“Hello, I’m Jean. With whom am I speaking?”
“Melissa Brown,” you say. “I’m a mental health clinician.
“Hi Melissa, how are you today?”
“Fine.”
“That’s great. Can I have a phone number for you, Melissa, in case we get disconnected?”
“Yes, it’s 213-456-7880.”
“Thank you, Melissa. How can I help you?”
“I need to do a concurrent review on a mutual member.”
“Sure, I can help you with that. But, first, you a provider?”
“Yes, I’m a licensed Marriage and Family Therapist.”
“Thank you. What is the member’s first and last name?”
“Mickey Mouse.”
“Member’s date of birth?”
“February 20th, 1907.”
“And what is the Member ID?”
“34XZHSDI”
“And your facility name?”
“El Santonio Health.”
“Your tax ID?”
“6789012.”
“The facility address?”
“2460 Todeo Drive, Los Angeles 45890.”
“So, Melissa, let me get you to the right person for a concurrent review.”
“Okay,” you say.
“Hi, my name is Mary. How can I help you today?”
“I need to do a concurrent review on a mutual member.”
“Sure, I can help you with that. But, first, you a provider?”
“Yes, I’m a licensed Marriage and Family Therapist.”
“Thank you. What is the member’s first and last name?”
“Mickey Mouse.”
“Date of birth?”
“February 20th, 1907.”
“And what’s the Member ID?”
“34XZHSDI.”
“And your facility name?”
“El Santonio Health.”
“Your tax ID?”
“6789012.”
“The facility address?”
“2460 Todeo Drive, Los Angeles 45890.”
“Melissa, I’ll need to transfer you if you are asking for authorization.”
“All right. But I just got transferred.”
“Yes, I apologize. Let me get you to the right person.”
Music. A faint voice answers.
“Hi, my name is Tracy B. Tell me what is going on with Mickey Mouse.”
“Finally, a person I can leave clinical information with! Thank you, Tracy.”
“No problem, Melissa.”
“I’ve only been 40 minutes on this call.”
“I thank you for your patience. So, why do you need mental health treatment for Mickey Mouse?”
“Well, he has delusions of grandeur; he thinks he’s awesome and that everyone wants to hug him. He has species dysphoria, thinking he’s a person. He becomes very reactive when anyone mistakes him for a mouse. Yesterday, he tried to cut one of his ears off. He has suicidal ideation with a plan—to jump into the “Pirates of the Caribbean” ride and drown himself. I’m asking for 20 days of partial hospitalization treatment at our mental health and addictions program.”
“Melissa, let me see what this disorder warrants.”
Music.
“Melissa?”
“Yes, I’m still here.”
“It’s Tracy. I’m authorizing 3 days of mental health treatment from June 1st, 2022 through June 4th, 2022.”
“3 days,” you repeat. Right. That will be enough to stabilize the patient. Sure. But you want to get off the phone. You’re thinking of all the work you need to do.
Tracy is talking:
“Yes, Melissa. The authorization number is 20HJ22. Please be aware that authorization is not a guarantee of payment. If you need additional days, please call back and speak to one of our reviewers.”
“Okay.”
“Is there anything else I can help you with today, Melissa?”
“No, thank you.”
“Have a nice day, Melissa!”
“You too.”
You hang up.
You enter the 3 days, whom you spoke with, when you need to call back, and the auth number into the computer.
You have half an hour now before program begins to grab a coffee and meet with Mickey.

Edna Wallace, LMFT, is a long-time therapist at El Camino Hospital working in the Adult Mood Program for Depression and Anxiety and the OATS program for older adults. She has a private practice in Los Altos. She worked for a decade on the Luncheon Committee for SCV-CAMFT and has been a luncheon presenter as well. Edna is an avid writer in her spare time.