If I Had to Rely on Medi-Cal, I Could Be Dead Right Now

The other day, I talked about applying for state benefits. It was to set up this post, about Medi-Cal. The previous post ended:

We got our first month of Food Stamps within one week of my applying. It was retroactive to the date I applied, so we actually got about $100 extra that first month.

Our application for Medi-Cal did not go so smoothly…

I applied for Food Stamps and Medi-Cal in the last full week of May. By the second week of June, we still didn’t have any word about Medi-Cal. I called my Food Stamps worker, who told me she was not my Medi-Cal worker. I called the person she directed me to. He directed me to yet another person. I called her. She was not a nice individual. She told me we would have our Medi-Cal cards the following week.

On Friday, June 8, my throat hurt enough that, if I had health insurance (like Medi-Cal) I would have gone to the doctor. But I didn’t, so I didn’t.

On Saturday, June 9, my throat hurt so much, I stayed in bed all day.

On Sunday, June 10, I woke up before 6 am, and swallowing liquid felt like swallowing shards of glass. I couldn’t drink tea. I had to go to the emergency room. There, I told everyone (quietly, because I couldn’t talk real loud) that I was supposed to be getting Medi-Cal that week, and it would be retroactive to the day I applied. I was initially told that I would have to give them $500 (WHAT?!?) but then a nurse told me, no, I didn’t. I ended up getting IV fluids, IV steroids, and prescriptions for antibiotics and pain medication. Then, I had to follow up with my doctor, who gave me stronger antibiotics and a round of oral steroids.

You can read more about my being sick if you’d like. The point is, if I had had Medi-Cal, I would have gone to the doctor (for about $136). I’m sure she would have prescribed antibiotics (somewhere between $60-$100). She might have also prescribed a steroid (again, around $100). I would not have had to go to the ER, although I likely would have had to go back to the doctor to get stronger meds (another $200 or so). For this medical attention, the state would have paid around $600.

My visit to the ER cost $4,500, and that doesn’t include the physician’s fee. I paid about $100 for the medications, because AAA has a prescription discount code. Also, Vicodin is really cheap. It’s scary.

When Max got sick, I told him to go straight to his doctor. The receptionist didn’t want to let him in to the appointment without his Medi-Cal card or the cost of the visit. I had her call me and I told her what “my worker” had been saying – we were approved and we would be getting our cards within the week. I guilted her into letting Max in, and he got the same drugs I got. Well, not the Vicodin, because he had caught the infection early, so didn’t need anything that strong.

Every week I called “my worker” and got the same story – we’d be getting our cards, “within the week.” By the last week of June, she finally admitted that she shouldn’t have told me that. Plus, she needed more documentation! So I sent that off immediately and waited… calling every week. The woman yelled at me. I didn’t care.

Our cards arrived the week of July 23. That’s a full two months after I applied. If I had had a serious illness, such as cancer, I would be dead right now. No one wanted to treat me without an insurance card or money. It was the promise of Medi-Cal, and the fact that I’m very persuasive, that got us in to see doctors when we needed them. The prescriptions weren’t prohibitively expensive, mostly due to the AAA discount, Food Stamps, and the fact that I pretty much stopped paying every other bill we had.*

I should note that, during this time, Cassie had private health insurance. We couldn’t let her lapse at all, because we hadn’t finalized yet, and she had to have health coverage.

By July 23, we actually had private health insurance through Max’s work. For the first time since we lost COBRA in 2010, Max and I had real health coverage! So, by the time we got our Medi-Cal cards, we didn’t need them.

Now, we did need them to cover our previous bills, which we did.

You would think, OK, we had our Medi-Cal cards to cover the old expenses, we had our new health insurance to cover future expenses. All is right with the world.

Hahahahaha!

Medi-Cal just got more confusing. They wanted us to choose a plan, which was basically Kaiser or the most restrictive PPO on the planet. Our doctors were not on either plan. My worker mistakenly told me to do nothing – to not choose. Someone from the plans called me. When I explained that we had private insurance now, and didn’t even need Medi-Cal, that person said I had to fill out a completely different form. Why? Because we still technically had Medi-Cal, and if we had private insurance, we couldn’t use one of the plans, we had to have “straight Medi-Cal.” So I filled out that form.

And then, as expected, we were denied for Medi-Cal. Because we had private insurance, and because Max’s income exceeded the allowable amount for us to have Medi-Cal. But we would get transitional Medi-Cal. Except that, a day later, I got a different letter saying we were denied that as well.

Meanwhile, Blue Cross sent us a form asking if we had other insurance. I really didn’t know. I tried to call the new Medi-Cal line. I was on hold for more than 1 hour three times. I just gave up. I didn’t fill out the Blue Cross form.

So Blue Cross decided it would deny all of our claims until I filled out the damn form.

I filled out the form and said we didn’t have Medi-Cal, because that was the last communication I got.

Last week, I got an application to extend transitional Medi-Cal. I thought we didn’t have it! When I filled out the form, I asked to have it terminated, effective August 2012. That way, I figured I didn’t lie to Blue Cross. Which I didn’t. I mean, I didn’t mean to. I thought we didn’t have Medi-Cal.

The bottom line? I love Food Stamps. I hate Medi-Cal. No, I don’t hate Medi-Cal. I hate the people who work for Medi-Cal. Because of their bureaucracy, I am sure that people do become sicker and, yes, die. Oh, and Sharonda? I should turn the other cheek and all that, but I actually hope that you encounter someone as awful at her job as you are. To be charitable, I hope you’re not dying when you do so.

* Well, maybe not every bill, but a lot of them.

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6 thoughts on “If I Had to Rely on Medi-Cal, I Could Be Dead Right Now

  1. It is such a shame that a service that is ment to help people in times of emergencies cannot get their acts together. Sadly, part of the blame goes to those who commit fraud and those who are not U.S. citizens.

    I am sorry you had to go through this nightmare.

    • Well, I have to disagree with you. Welfare fraud occurs in less than 1% of cases. Undocumented immigrants aren’t eligible for most benefits. It only took the Food Stamps office 1 week to verify the SSNs for Max, Jackson, and me, and they accepted the notarized document signed by our attorney as proof of Cassie’s birth and adoption status. After more than a month of having our info, Medi-Cal needed to have copies of the titles to our cars. Why? Because a family of four is going to sell 13- and 14-year old cars to get a couple thousand dollars which would only pay for two months of health insurance? Yeah, that makes total sense.

  2. Our insurance sent us a letter telling us that baby girls hearing test and audiologist appt would not be covered because it was a “preexisting” condition. Baby girl was on Medicaid in PA until she left PA. The day we got back home we added her to our insurance here at home. Our insurance tried to tell us we had to prove that she did not have a preexisting condition. Fortunately I knew that since she was added as soon as she was placed in our custody that there was no preexisting condition clause (so even if she had a preexisting condition they couldn’t exclude her the same as a biological child). Although she didnt go to the audiologist for a preexisting condition and was never treated in her month on Medicaid for anything audiology related I still refused to fill out the form. Insurance companies bank on people not knowing the law. Had I not understood my daughters rights and she had been treated by an audiologist while in PA the insurance company would have charged me out of pocket. I didn’t fill out the form for a few reasons 1) I never should have been asked to in the first place and 2) her only preexisting condition was birth. Adoption makes insurance all the more complicated.

  3. It’s unfortunate that the system is so complicated to navigate. Even as a social worker, sometimes I’m amazed at the loops that some of my families have had to jump through.

    • It’s not just the hoops – it’s the duplication. I had to fill out the same form in person that I filled out online. Then there are the computer generated messages that contradict one another, and you can’t get a person to answer the phone. It’s madness, I tell you!

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