To: The California State House
Managed Medi-cal let’s down disabled patients by not providing needed services
Anthem Blue Cross Managed Medi-cal is denying severely disabled patients necessary medical treatments, specialists, and services out of their network.
Why is this important?
Switching from straight Medi-cal to Managed Medi-cal in rural counties especially, has made accessing necessary out of network specialists, services, and expensive treatments and equipment harder for severely disabled patients.
In Tuolumne (and many other rural California counties) there are not enough primary care physicians and specialists to adequately serve all the people in Tuolumne and the surrounding rural counties. Primary Care Physicians that except Medi-cal have become scarce. Resulting in PCP’s that do accept Medi-cal to have bigger patient loads than they can adequately care for. The Tuolumne Me-wuk Cedar Road Health Center has had to limit their doctors to 20min time slots for each patient. Which is more than enough time for a patient just needing a medication refill for something like blood pressure meds, but not nearly enough time for a very complex disabled patient like myself. Even having appointments at least once a month, there’s only time to treat the most urgent needs. Due to being restricted to only PCP’s taking Anthem Blue Cross Managed Medi-cal, I’m limited to very few doctors. I’m not even able to go to a bigger surrounding cities like Modesto, as they have their own Medi-cal system.
Sonora Adventist is bragging about their Rural Health Clinic and talking about expanding it to other surrounding counties. What they don’t say though is that the waits to see a lot of the specialists are quite lengthy even if the need to see the specialist is very urgent. For example their nephrologist only works at the Forest Road Rural Health Clinic every other month for only HALF a DAY! That’s not nearly often enough to adequately treat all the local patients in need. My PCP put in an urgent referral and the soonest appointment was over 6 months out, just for an initial consultation. Patients that have private insurance can see these specialists much sooner at their main offices where they work many more days then at the Rural Health Clinic. Medi-cal patients typically can only see these specialists when they work at the rural health clinic which is typically only one or two times a month at most.
Anthem does everything them can to delay referrals to specialists especially out of network. Anthem stopped contracting with Stanford about 2 years ago. I’ve been to both UC Davis and UCSF which are in network but neither had specialists that match my extremely rare disease process. Stanford is the only hospital in Northern California that has experience in treating the different aspects of my extremely rare disease process. Complex medical conditions qualify patients to be released from the restrictions of Managed Medi-cal. My application to switch to straight Medi-cal was denied. My appeal of this decision was denied by the California Department of Health Care Services. The judge, Steven V. Alder, ruled that Anthem Blue Crosses Managed Medi-cal health care plan could adequately cover my needs. In over 6 months since the hearing, Anthem has constantly blocked my physicians requests for desperately needed equipment, medications, and the same referrals we’ve been trying to get through for over 2 years now.
I no longer have time to fight and wait on Anthem to approve these necessary services or to go through the appeal process to get straight Medi-cal for the 4th time in just over 3 years. My parents and I should be focusing time on making memories, NOT spending multiple hours a day almost every day fighting for the services I need and not really ever getting anywhere.
I think rural counties, like Tuolumne county should either switch back to just straight Medi-cal or make it much easier for very complex patients like me to be able to be exempted from Managed Medi-cal programs, like Anthem Blue Cross.
In Tuolumne (and many other rural California counties) there are not enough primary care physicians and specialists to adequately serve all the people in Tuolumne and the surrounding rural counties. Primary Care Physicians that except Medi-cal have become scarce. Resulting in PCP’s that do accept Medi-cal to have bigger patient loads than they can adequately care for. The Tuolumne Me-wuk Cedar Road Health Center has had to limit their doctors to 20min time slots for each patient. Which is more than enough time for a patient just needing a medication refill for something like blood pressure meds, but not nearly enough time for a very complex disabled patient like myself. Even having appointments at least once a month, there’s only time to treat the most urgent needs. Due to being restricted to only PCP’s taking Anthem Blue Cross Managed Medi-cal, I’m limited to very few doctors. I’m not even able to go to a bigger surrounding cities like Modesto, as they have their own Medi-cal system.
Sonora Adventist is bragging about their Rural Health Clinic and talking about expanding it to other surrounding counties. What they don’t say though is that the waits to see a lot of the specialists are quite lengthy even if the need to see the specialist is very urgent. For example their nephrologist only works at the Forest Road Rural Health Clinic every other month for only HALF a DAY! That’s not nearly often enough to adequately treat all the local patients in need. My PCP put in an urgent referral and the soonest appointment was over 6 months out, just for an initial consultation. Patients that have private insurance can see these specialists much sooner at their main offices where they work many more days then at the Rural Health Clinic. Medi-cal patients typically can only see these specialists when they work at the rural health clinic which is typically only one or two times a month at most.
Anthem does everything them can to delay referrals to specialists especially out of network. Anthem stopped contracting with Stanford about 2 years ago. I’ve been to both UC Davis and UCSF which are in network but neither had specialists that match my extremely rare disease process. Stanford is the only hospital in Northern California that has experience in treating the different aspects of my extremely rare disease process. Complex medical conditions qualify patients to be released from the restrictions of Managed Medi-cal. My application to switch to straight Medi-cal was denied. My appeal of this decision was denied by the California Department of Health Care Services. The judge, Steven V. Alder, ruled that Anthem Blue Crosses Managed Medi-cal health care plan could adequately cover my needs. In over 6 months since the hearing, Anthem has constantly blocked my physicians requests for desperately needed equipment, medications, and the same referrals we’ve been trying to get through for over 2 years now.
I no longer have time to fight and wait on Anthem to approve these necessary services or to go through the appeal process to get straight Medi-cal for the 4th time in just over 3 years. My parents and I should be focusing time on making memories, NOT spending multiple hours a day almost every day fighting for the services I need and not really ever getting anywhere.
I think rural counties, like Tuolumne county should either switch back to just straight Medi-cal or make it much easier for very complex patients like me to be able to be exempted from Managed Medi-cal programs, like Anthem Blue Cross.