• Contact
  • Privacy Policy
  • Terms & Conditions
Sunday, March 26, 2023
InsureMonkey.com
No Result
View All Result
  • Home
  • Insurance Education
    Infertility coverage 101: understanding your fertility benefits

    Infertility coverage 101: understanding your fertility benefits

    How to find a therapist if you’ve never had one before

    How to find a therapist if you’ve never had one before

    Should I go to the ER, Urgent Care or My Doctor’s Office?

    Should I go to the ER, Urgent Care or My Doctor’s Office?

    Embarrassed to ask questions at the doctor? Five tips to open the conversation

    Embarrassed to ask questions at the doctor? Five tips to open the conversation

    5 questions to ask before picking a health insurance plan

    5 questions to ask before picking a health insurance plan

    How price shopping for health care can save you money (and how to do it)

    How price shopping for health care can save you money (and how to do it)

    The three words every patient in the U.S. healthcare system should know

    The three words every patient in the U.S. healthcare system should know

    Caring Beyond the Chat Window

    Caring Beyond the Chat Window

  • Health Insurance
    Obamacare at 13: Biden and a KHN Reporter Remember

    Obamacare at 13: Biden and a KHN Reporter Remember

    Health Providers Scramble to Keep Remaining Staff Amid Medicaid Rate Debate

    Health Providers Scramble to Keep Remaining Staff Amid Medicaid Rate Debate

    Journalists Put Polio, Price Transparency, and a Personal Covid Battle in Perspective

    Journalists Discuss Medicaid Unwinding and Clawbacks

    Two Counties Square Off With California Over Mental Health Duties

    Two Counties Square Off With California Over Mental Health Duties

    Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients

    Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients

    Planes de salud de Medicaid intentan proteger a sus miembros… y a sus ganancias

    Medicaid Health Plans Try to Protect Members — And Profits — During Unwinding

    Planes de salud de Medicaid intentan proteger a sus miembros… y a sus ganancias

    Planes de salud de Medicaid intentan proteger a sus miembros… y a sus ganancias

    Why Does Insulin Cost So Much? Big Pharma Isn’t the Only Player Driving Prices

    Why Does Insulin Cost So Much? Big Pharma Isn’t the Only Player Driving Prices

    Idaho Dropped Thousands From Medicaid in the Pandemic’s First Years

    Idaho Dropped Thousands From Medicaid in the Pandemic’s First Years

  • Insurance for Business
    S Corp owners and QSEHRA

    S Corp owners and QSEHRA

    THE ROLE OF HEALTH SAVINGS ACCOUNTS IN BUSINESS HEALTH INSURANCE PLANS

    THE ROLE OF HEALTH SAVINGS ACCOUNTS IN BUSINESS HEALTH INSURANCE PLANS

    HOW TO NAVIGATE THE HEALTH INSURANCE MARKETPLACE TO FIND THE BEST PLAN FOR YOUR COMPANY

    HOW TO NAVIGATE THE HEALTH INSURANCE MARKETPLACE TO FIND THE BEST PLAN FOR YOUR COMPANY

    HOW TO CREATE A FLEXIBLE AND CUSTOMIZED HEALTH INSURANCE PLAN FOR YOUR BUSINESS

    HOW TO CREATE A FLEXIBLE AND CUSTOMIZED HEALTH INSURANCE PLAN FOR YOUR BUSINESS

    Automate QSEHRA reimbursements through payroll

    Automate QSEHRA reimbursements through payroll

    Comparing ICHRA vs. QSEHRA | What’s the difference?

    Comparing ICHRA vs. QSEHRA | What’s the difference?

    How to set up a QSEHRA

    How to set up a QSEHRA

    Updated 2023 | Is a health insurance stipend right for my business?

    Updated 2023 | Is a health insurance stipend right for my business?

    List of Eligible HRA Expenses

    List of Eligible HRA Expenses

  • Life Insurance
    Secure Your Family’s Future with a $50,000 Life Insurance Policy

    Secure Your Family’s Future with a $50,000 Life Insurance Policy

    Why Bad Habits Can Ruin Your Retirement Plans

    Why Bad Habits Can Ruin Your Retirement Plans

    Do I Need Life Insurance If I Have A Mortgage?

    Do I Need Life Insurance If I Have A Mortgage?

    Learn How to Turn Profits from a Policy

    Learn How to Turn Profits from a Policy

    Quality Coverage Without Breaking the Bank

    Quality Coverage Without Breaking the Bank

    Globe Life Insurance Review | Do they offer the best life insurance rates?

    Globe Life Insurance Review | Do they offer the best life insurance rates?

    What You Need to Know Before Buying

    What You Need to Know Before Buying

    How to Get Life Insurance with ADHD [7 Steps with Pictures]

    How to Get Life Insurance with ADHD [7 Steps with Pictures]

    Discover The Least Expensive Life Insurance for 36 Year Olds

    Discover The Least Expensive Life Insurance for 36 Year Olds

  • Casualty Insurance
    Is Long-Term Disability Insurance Worth Paying For?

    Is Long-Term Disability Insurance Worth Paying For?

    Maintaining Your Quality Of Life When You Suffer Long-Term Disabilities In Florida

    Maintaining Your Quality Of Life When You Suffer Long-Term Disabilities In Florida

    Filing For Long-Term Disability Benefits? Find Out What To Do If You Get A Denial Letter

    Filing For Long-Term Disability Benefits? Find Out What To Do If You Get A Denial Letter

    Six Types Of People At Risk For Long-Term Disabilities

    Six Types Of People At Risk For Long-Term Disabilities

    Social Security Disability Benefits: Your Rights And Responsibilities

    Social Security Disability Benefits: Your Rights And Responsibilities

    Five Common Questions Insurers Ask When Reviewing Long-Term Disability Claims

    Five Common Questions Insurers Ask When Reviewing Long-Term Disability Claims

    Frank N. Darras Once Again Recognized as a 2023 Southern California Super Lawyer

    Frank N. Darras Once Again Recognized as a 2023 Southern California Super Lawyer

    Four Ways To Appeal Denied Social Security Disability Claim

    Four Ways To Appeal Denied Social Security Disability Claim

    Frank N. Darras Honored by Lawdragon for 18th Year in a Row

    Frank N. Darras Honored by Lawdragon for 18th Year in a Row

  • More
    • Health Care
    • Medicare
  • Home
  • Insurance Education
    Infertility coverage 101: understanding your fertility benefits

    Infertility coverage 101: understanding your fertility benefits

    How to find a therapist if you’ve never had one before

    How to find a therapist if you’ve never had one before

    Should I go to the ER, Urgent Care or My Doctor’s Office?

    Should I go to the ER, Urgent Care or My Doctor’s Office?

    Embarrassed to ask questions at the doctor? Five tips to open the conversation

    Embarrassed to ask questions at the doctor? Five tips to open the conversation

    5 questions to ask before picking a health insurance plan

    5 questions to ask before picking a health insurance plan

    How price shopping for health care can save you money (and how to do it)

    How price shopping for health care can save you money (and how to do it)

    The three words every patient in the U.S. healthcare system should know

    The three words every patient in the U.S. healthcare system should know

    Caring Beyond the Chat Window

    Caring Beyond the Chat Window

  • Health Insurance
    Obamacare at 13: Biden and a KHN Reporter Remember

    Obamacare at 13: Biden and a KHN Reporter Remember

    Health Providers Scramble to Keep Remaining Staff Amid Medicaid Rate Debate

    Health Providers Scramble to Keep Remaining Staff Amid Medicaid Rate Debate

    Journalists Put Polio, Price Transparency, and a Personal Covid Battle in Perspective

    Journalists Discuss Medicaid Unwinding and Clawbacks

    Two Counties Square Off With California Over Mental Health Duties

    Two Counties Square Off With California Over Mental Health Duties

    Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients

    Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients

    Planes de salud de Medicaid intentan proteger a sus miembros… y a sus ganancias

    Medicaid Health Plans Try to Protect Members — And Profits — During Unwinding

    Planes de salud de Medicaid intentan proteger a sus miembros… y a sus ganancias

    Planes de salud de Medicaid intentan proteger a sus miembros… y a sus ganancias

    Why Does Insulin Cost So Much? Big Pharma Isn’t the Only Player Driving Prices

    Why Does Insulin Cost So Much? Big Pharma Isn’t the Only Player Driving Prices

    Idaho Dropped Thousands From Medicaid in the Pandemic’s First Years

    Idaho Dropped Thousands From Medicaid in the Pandemic’s First Years

  • Insurance for Business
    S Corp owners and QSEHRA

    S Corp owners and QSEHRA

    THE ROLE OF HEALTH SAVINGS ACCOUNTS IN BUSINESS HEALTH INSURANCE PLANS

    THE ROLE OF HEALTH SAVINGS ACCOUNTS IN BUSINESS HEALTH INSURANCE PLANS

    HOW TO NAVIGATE THE HEALTH INSURANCE MARKETPLACE TO FIND THE BEST PLAN FOR YOUR COMPANY

    HOW TO NAVIGATE THE HEALTH INSURANCE MARKETPLACE TO FIND THE BEST PLAN FOR YOUR COMPANY

    HOW TO CREATE A FLEXIBLE AND CUSTOMIZED HEALTH INSURANCE PLAN FOR YOUR BUSINESS

    HOW TO CREATE A FLEXIBLE AND CUSTOMIZED HEALTH INSURANCE PLAN FOR YOUR BUSINESS

    Automate QSEHRA reimbursements through payroll

    Automate QSEHRA reimbursements through payroll

    Comparing ICHRA vs. QSEHRA | What’s the difference?

    Comparing ICHRA vs. QSEHRA | What’s the difference?

    How to set up a QSEHRA

    How to set up a QSEHRA

    Updated 2023 | Is a health insurance stipend right for my business?

    Updated 2023 | Is a health insurance stipend right for my business?

    List of Eligible HRA Expenses

    List of Eligible HRA Expenses

  • Life Insurance
    Secure Your Family’s Future with a $50,000 Life Insurance Policy

    Secure Your Family’s Future with a $50,000 Life Insurance Policy

    Why Bad Habits Can Ruin Your Retirement Plans

    Why Bad Habits Can Ruin Your Retirement Plans

    Do I Need Life Insurance If I Have A Mortgage?

    Do I Need Life Insurance If I Have A Mortgage?

    Learn How to Turn Profits from a Policy

    Learn How to Turn Profits from a Policy

    Quality Coverage Without Breaking the Bank

    Quality Coverage Without Breaking the Bank

    Globe Life Insurance Review | Do they offer the best life insurance rates?

    Globe Life Insurance Review | Do they offer the best life insurance rates?

    What You Need to Know Before Buying

    What You Need to Know Before Buying

    How to Get Life Insurance with ADHD [7 Steps with Pictures]

    How to Get Life Insurance with ADHD [7 Steps with Pictures]

    Discover The Least Expensive Life Insurance for 36 Year Olds

    Discover The Least Expensive Life Insurance for 36 Year Olds

  • Casualty Insurance
    Is Long-Term Disability Insurance Worth Paying For?

    Is Long-Term Disability Insurance Worth Paying For?

    Maintaining Your Quality Of Life When You Suffer Long-Term Disabilities In Florida

    Maintaining Your Quality Of Life When You Suffer Long-Term Disabilities In Florida

    Filing For Long-Term Disability Benefits? Find Out What To Do If You Get A Denial Letter

    Filing For Long-Term Disability Benefits? Find Out What To Do If You Get A Denial Letter

    Six Types Of People At Risk For Long-Term Disabilities

    Six Types Of People At Risk For Long-Term Disabilities

    Social Security Disability Benefits: Your Rights And Responsibilities

    Social Security Disability Benefits: Your Rights And Responsibilities

    Five Common Questions Insurers Ask When Reviewing Long-Term Disability Claims

    Five Common Questions Insurers Ask When Reviewing Long-Term Disability Claims

    Frank N. Darras Once Again Recognized as a 2023 Southern California Super Lawyer

    Frank N. Darras Once Again Recognized as a 2023 Southern California Super Lawyer

    Four Ways To Appeal Denied Social Security Disability Claim

    Four Ways To Appeal Denied Social Security Disability Claim

    Frank N. Darras Honored by Lawdragon for 18th Year in a Row

    Frank N. Darras Honored by Lawdragon for 18th Year in a Row

  • More
    • Health Care
    • Medicare
No Result
View All Result
Morning News
No Result
View All Result
Home Health Insurance

California’s Massive Medicaid Program Works for Some, but Fails Many Others

March 2, 2023
in Health Insurance
0
California’s Massive Medicaid Program Works for Some, but Fails Many Others
0
SHARES
1
VIEWS
Share on FacebookShare on Twitter

READ ALSO

Obamacare at 13: Biden and a KHN Reporter Remember

Health Providers Scramble to Keep Remaining Staff Amid Medicaid Rate Debate

Newborns. Former inmates. School college students. Expectant mothers. Folks with disabilities. Foster youngsters. Homeless folks. Single dads.

Your neighbor. Your co-worker.

You.

California’s Medicaid program, known as Medi-Cal, serves a whopping 15.4 million folks, providing care from cradle to grave: Half of all births are coated by Medi-Cal, as are greater than half of all stays in nursing houses.

Every little thing about Medi-Cal is huge, from its upcoming fiscal yr price range of $139 billion to the expansive listing of advantages and providers it gives. The best way this system works — or doesn’t — may spell life or loss of life for a lot of enrollees.

“It’s crucial, from the only pregnant mother, to the extraordinarily frail aged inhabitants that wants a nursing dwelling,” mentioned Jennifer Kent, former director of the state Division of Well being Care Providers, which administers Medi-Cal. “If it weren’t for Medi-Cal, so many individuals would both be useless or can be severely compromised.”

In a brand new sequence, California Healthline will make clear Medi-Cal’s successes and failures by way of the experiences of its enrollees. They embody Stephanie Lammers, who can’t get her troubling belly signs checked at a clinic 50 miles from her small Calaveras County city as a result of the transportation Medi-Cal is meant to supply isn’t reliable; Carolina Morga Tapia, a Fresno girl who credit Medi-Cal with serving to her have 5 wholesome youngsters; and Lucas Moreno Ramirez, a Los Angeles County man with stage 4 lung most cancers who needed to struggle to maintain his therapy going.

Medi-Cal is at a crucial juncture because it makes an attempt to serve the wants of a various affected person inhabitants with a dizzying array of medical wants — from childhood vaccinations and most cancers screenings to state-of-the-art take care of uncommon genetic issues. Roughly half of enrollees are Hispanic, and, subsequent yr, California will turn out to be the primary state to increase eligibility to all immigrants who qualify, no matter their authorized standing.

Medi-Cal can also be enterprise a number of new initiatives that purpose to save lots of taxpayer cash and enhance high quality. State officers are demanding that the 23 well being insurers that serve most Medi-Cal sufferers present higher care — or face important penalties, together with potential expulsion from this system.

The state can also be including modern social providers that fall outdoors the standard realm of drugs, together with serving to some enrollees pay for hire and purchase groceries.

“Persons are watching California,” mentioned Cindy Mann, who served as federal Medicaid director below former President Barack Obama. “What the state is doing is formidable and really aggressive. It makes a big mark on well being care and well being coverage, not simply due to the dimensions and breadth of its program, however by being very complete.”

However solely a sliver of enrollees will get the brand new social providers, at the same time as many sufferers battle to acquire primary care or get in to see their medical doctors. In actuality, the kind of care you get in Medi-Cal is determined by the place you reside and which insurer supplies your advantages.

Meaning this system is working for some, however failing for a lot of others.

In case you are in Medi-Cal, we wish to hear from you, whether or not you reside in an enormous metropolis or a rural area, no matter your age, race, or ethnicity, and no matter your medical, dental, or psychological well being situation. Have you ever had issue seeing the suitable physician for what ails you, even to the purpose of placing your life in danger? Or did Medi-Cal present excellent care, maybe sparing you severe hurt or incapacity? Both means, please think about sharing your expertise with us.

See also  Centene Agrees to $215 Million Settlement With California for Alleged Medicaid Overbilling

Listed below are snapshots of sufferers who’ve used this system at a crucial time of their life.

Stephanie Lammers stands in the front door of her house and looks directly towards the camera. Her dog is visible in the window beside her.
Stephanie Lammers says the trip service supplied by her Medi-Cal well being plan is so dangerous that she stopped attempting to make use of it a few yr in the past, after it left her within the lurch a number of instances. “I simply don’t go to the physician anymore,” she says.(Wealthy Pedroncelli for KHN)

‘I Simply Don’t Go to the Physician Anymore’

When Stephanie Lammers leans over to placed on her sneakers, it feels as if she’s squishing one thing inside her stomach, she mentioned.

Lammers, 53, has been affected by frequent bouts of nausea, ache, and bloating for six months.

Her gastroenterologist needs to carry out diagnostic procedures, together with a colonoscopy and, if something reveals up, a biopsy. However Lammers, who lives in a motel together with her boyfriend and teenage daughter within the Gold Rush city of San Andreas, doesn’t have a working automobile and may’t readily get to the clinic — which is 50 miles away.

For Lammers, like many Medi-Cal enrollees who reside in rural areas, lack of transportation is a serious obstacle to acquiring care. The issue is especially acute for sufferers who must see specialists.

Lammers’ dermatologist and eye physician are over an hour away from San Andreas, the county seat of Calaveras County, about 125 miles northeast of San Francisco. She isn’t seeing a neurologist, regardless of a sequence of mini-strokes and stress-related seizures. And he or she hasn’t been to a podiatrist in two years, though her toes are twisted over each other and hold down, inflicting her to journey. She’s typically in excruciating ache when she walks.

Stephanie Lammers pets her dog, who is standing on its hind legs with its front paws on her shoulders, visibly jubilant from the affection.
Stephanie Lammers, pictured together with her canine, Shinook, has horrible ache in her toes. She regularly journeys as a result of her toes cross over each other and hold down, however she hasn’t seen a podiatrist in two years. (Wealthy Pedroncelli for KHN)

Medi-Cal is meant to supply free transportation to enrollees who can’t in any other case get to their appointments.

However Lammers, whose well being plan is California Well being & Wellness, owned by Centene, the nation’s largest industrial Medicaid insurer, stopped utilizing its trip service almost a yr in the past, after she missed dozens of appointments as a result of drivers simply didn’t present up, she mentioned. She was getting threatening letters from medical doctors’ workplaces over the no-shows.

As soon as she needed to hitchhike greater than 30 miles dwelling from a counseling appointment. On different events, Lammers mentioned, she didn’t obtain the reimbursement she was owed for arranging her personal rides.

“I simply don’t go to the physician anymore,” Lammers mentioned. “If I am going to the physician, my boyfriend has to take the time without work work, and if he takes the time without work work, we now have no cash.”

Over the last three months of 2022, Lammers canceled 5 appointments she had scheduled for the diagnostic belly procedures as a result of her boyfriend needed to work every time and couldn’t take her. She lastly stopped rescheduling.

California Well being & Wellness contracts with Modivcare, a Denver-based medical transportation firm that’s no stranger to affected person complaints and lawsuits.

Earlier than she gave up on the trip service, Lammers mentioned, she would name California Well being & Wellness to attempt to resolve the difficulty, solely to be instructed that Modivcare was a separate firm. “I’m like, ‘In case you guys employed them and put them accountable for transportation, who oversees their screw-ups?’”

Courtney Schwyzer, a member of a authorized assist workforce representing Lammers on varied Medi-Cal issues, mentioned the failure of medical trip providers is a systemic downside. In late February, Schwyzer and her fellow attorneys filed a petition in courtroom that she hopes will pressure the state Division of Well being Care Providers to handle the issue.

See also  Path Cleared for Georgia to Launch Work Requirements for Medicaid

California Well being & Wellness spokesperson Darrel Ng mentioned the corporate displays the standard of its contractors, however a scarcity of transportation suppliers in rural areas “has created distinctive challenges.”

Modivcare supplies greater than 4 million rides for Medi-Cal recipients yearly, and greater than 99% are with out criticism, mentioned Melody Lai, an organization spokesperson.

Lammers, who’s unemployed and attempting to begin a customized craft enterprise known as Stuff by Steph, mentioned medical doctors have warned her that if she doesn’t scale back her stress degree, it may shorten her life. However arranging medical care is probably the most annoying factor in her life proper now, so she doesn’t strive anymore.

“With a purpose to hold from dying, I’ve to not go to the physician,” she mentioned.

Carolina Morga Tapia stands outside, amid almond trees. The trees have no leaves, signaling the time of year.
Carolina Morga Tapia stands amid almond timber outdoors her dwelling in Fresno, California. She, her husband, and their 5 youngsters are enrolled in Medi-Cal, and she or he says she may be very pleased with the care it has supplied, together with emergency surgical procedure that saved her life after she fell gravely unwell throughout her second being pregnant.(Heidi de Marco / KHN)

‘It’s a Blessing’

Medi-Cal helped save the lifetime of Carolina Morga Tapia, a 30-year-old, full-time mom of 5 who lives together with her household amid almond groves in an agricultural enclave of Fresno.

9 years in the past, a bacterial an infection triggered untimely labor in the course of the twenty fifth week of her second being pregnant, and Morga Tapia virtually died. She spiked a fever, bled profusely, and wanted speedy transfusions and emergency surgical procedure. After a number of days in crucial care, she totally recovered.

However the medical doctors couldn’t cease the untimely delivery, and her child got here out weighing simply 1 pound. She and her husband, David Nuñez, named her Milagros Guadalupe, and she or he died 4 days later, on Sept. 13, 2013 — a Friday.

In every of her subsequent pregnancies, Medi-Cal paid for Morga Tapia to get pictures of artificial progesterone, meant to forestall one other preterm delivery. These pictures — one every week for about 20 weeks — can price a mean of greater than $10,000 per being pregnant.

Morga Tapia and Nuñez, a development employee, signed up for Medi-Cal when she was pregnant together with her first baby greater than a decade in the past. They’ve been on the identical Anthem Blue Cross Medi-Cal plan ever since.

“It saves some huge cash, and it’s a blessing to have that further assist.”

Morga Tapia

The plan paid for prenatal care by way of all six of Morga Tapia’s pregnancies, and it has supplied all of the medical and dental care the household wants, she mentioned.

“With out Medi-Cal, we must be paying for all of our kids,” mentioned Morga Tapia. “It saves some huge cash, and it’s a blessing to have that further assist.”

Her youngsters, 4 ladies and a boy, vary in age from 1 to 10. All of them go to the identical youngsters’s clinic and see the identical pediatrician.

The youngsters, all in good well being, get routine checkups, vaccinations, and different preventive care, Morga Tapia mentioned. She will get appointment reminders by way of textual content and playing cards within the mail notifying her when it’s time for the children’ vaccinations and wellness checks, in addition to her Pap smears, she mentioned.

Her household’s expertise contrasts sharply with the state’s evaluation of their well being plan, based on a report on high quality of care in Medi-Cal issued late final yr. The report, which evaluated Medi-Cal well being plans on pediatric care, ladies’s well being, and power illness administration, put Anthem Blue Cross within the lowest tier, and beneath par on a number of measures in quite a few counties, together with Fresno.

One other state report, launched in late January, detailed how rapidly insurers present appointments for his or her sufferers, and put Anthem Blue Cross’ Medi-Cal plan close to the underside of the heap.

See also  Should Medicaid recipients worry about losing their coverage in 2022?

Anthem Blue Cross spokesperson Michael Bowman mentioned in a press release that the interval coated within the experiences coincided with the covid-19 pandemic, “when our security internet suppliers handled important challenges with workforce and appointment availability.”

Morga Tapia doesn’t give the insurer low marks. “It’s totally different for everyone. I’ve an excellent wholesome household, and what Medi-Cal covers is actually lucky for us,” she mentioned.

Lucas Moreno Ramirez sits at his kitchen table and looks directly at the camera. His medication is visible beside him.
Lucas Moreno Ramirez has late-stage lung most cancers, and in 2021, medical doctors gave him only some months to reside. However the Los Angeles County man declined hospice and fought for a distinct therapy. Two years later, Moreno Ramirez remains to be alive and says his painful cough has subsided.(Heidi de Marco / KHN)

‘I Don’t Wish to Die But’

In late 2021, medical doctors gave Lucas Moreno Ramirez a number of months to reside.

Scuffling with diabetes and late-stage lung most cancers, Moreno Ramirez suffered debilitating ache as he hacked and labored for breath. His medical doctors really useful that he cease therapy and begin hospice care.

He felt as in the event that they had been giving up on him.

“They mentioned they’re going to present me opioids for my ache and assist me have a snug loss of life,” mentioned Moreno Ramirez, 68, who lives in Norwalk, in Los Angeles County. “I instructed them I don’t imagine in that. I don’t wish to die but.”

A former landscaper and manufacturing unit employee, Moreno Ramirez realized he needed to be his personal advocate, combating for the care he believed he deserved from Medi-Cal.

He mentioned his Christian religion gave him power, and over the following few months, Moreno Ramirez pushed this system and his medical doctors to maintain battling his most cancers, utilizing a distinct therapy with fewer uncomfortable side effects than chemotherapy.

“I imagine in prayer,” he mentioned. “However I imagine in science and medicine, too.”

The photograph shows a box of medication Lucas takes for his lung cancer. It is a white box with blue lettering that reads, "Albuterol Sulfate Inhalation Solution." A nebulizer compressor kit is also visible.
Lucas Moreno Ramirez has taken his care into his personal arms and says he’s not in ache, his cough has subsided, and he feels eager for the long run.(Heidi de Marco / KHN)

Moreno Ramirez is without doubt one of the roughly 1.6 million Californians enrolled in each Medicare, which covers people who find themselves 65 and older or have disabilities, and Medi-Cal, which kicks in to cowl the prices and advantages that Medicare doesn’t.

He additionally depends on his Medi-Cal insurer to assist him navigate the byzantine system. L.A. Care, the most important Medi-Cal plan with almost 2.6 million members, related him with a care supervisor who labored with him to determine a distinct therapy known as Tagrisso and advocated for him to get it. 

Even with the brand new remedy, Moreno Ramirez’s coughing suits returned final yr, and his signs grew so painful he suspected the most cancers was rising. He requested to see his pulmonologist however was instructed the primary appointment can be in June 2023. So he switched medical doctors and scored an appointment almost six months sooner.

“My previous physician didn’t assist me. I didn’t belief him,” Moreno Ramirez mentioned. “He was all the time too busy for me. I instructed my medical doctors, ‘Give me an opportunity.’”

Having taken his care into his personal arms, he says he’s not in ache, his cough has subsided, and he feels eager for the long run. “Now I really feel good,” he mentioned.

He has additionally sought extra consideration for his diabetes and obtained a steady glucose monitor to measure his blood sugar. It’s higher managed now than it has been in many years, he mentioned.

“It’s important to arise for your self and advocate,” mentioned Joann Pacelo, the care supervisor who helped Moreno Ramirez change medical doctors, get faster referrals to specialists, and get accepted for in-home nursing visits.

“Lots of instances it’s troublesome with Medi-Cal as a result of the medical doctors are busy and the reimbursements are so low, however nobody must be denied the care they deserve.”

This story was produced by KHN, which publishes California Healthline, an editorially unbiased service of the California Well being Care Basis.

Associated Subjects

Contact Us

Submit a Story Tip

Tags: CaliforniasFailsMassiveMedicaidProgramWorks

Related Posts

Obamacare at 13: Biden and a KHN Reporter Remember
Health Insurance

Obamacare at 13: Biden and a KHN Reporter Remember

March 25, 2023
Health Providers Scramble to Keep Remaining Staff Amid Medicaid Rate Debate
Health Insurance

Health Providers Scramble to Keep Remaining Staff Amid Medicaid Rate Debate

March 24, 2023
Journalists Put Polio, Price Transparency, and a Personal Covid Battle in Perspective
Health Insurance

Journalists Discuss Medicaid Unwinding and Clawbacks

March 18, 2023
Two Counties Square Off With California Over Mental Health Duties
Health Insurance

Two Counties Square Off With California Over Mental Health Duties

March 15, 2023
Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients
Health Insurance

Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients

March 13, 2023
Planes de salud de Medicaid intentan proteger a sus miembros… y a sus ganancias
Health Insurance

Medicaid Health Plans Try to Protect Members — And Profits — During Unwinding

March 11, 2023
Next Post
5 Takeaways From House GOP’s First Hearing on COVID-19

5 Takeaways From House GOP’s First Hearing on COVID-19

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

POPULAR ARTICLES

Guide to Health Insurance in Singapore for Foreigners (Expats & Dependents)

Guide to Health Insurance in Singapore for Foreigners (Expats & Dependents)

August 13, 2022
Aetna vs Anthem Blue Cross. Which Health Insurance Is Better?

Aetna vs Anthem Blue Cross. Which Health Insurance Is Better?

September 5, 2022
Hospices Have Become Big Business for Private Equity Firms, Raising Concerns About End-of-Life Care

Hospices Have Become Big Business for Private Equity Firms, Raising Concerns About End-of-Life Care

August 1, 2022
How to avoid this BIG Medicare mistake • IM

2023 IRMAA Fees & How to Appeal Them • IM

December 17, 2022
How to Find a Health Insurance Broker

How to Find a Health Insurance Broker

October 11, 2022

EDITOR'S PICK

Too Late to Get Health Insurance?

Too Late to Get Health Insurance?

August 20, 2022
Four Common Problems People With Long-Term Disabilities In Florida Face

Four Common Problems People With Long-Term Disabilities In Florida Face

December 17, 2022
Considering Medicare Advantage? Get the Facts

Considering Medicare Advantage? Get the Facts

August 19, 2022
What Is Cash Surrender Value?

What Is Cash Surrender Value?

August 15, 2022

About

Our mission is to develop a community of people who try to make financially sound decisions. This website strives to educate individuals in making wise choices about their everyday insurance needs.

Categories

  • Casualty Insurance
  • Health Care
  • Health Insurance
  • Insurance Education
  • Insurance for Business
  • Life Insurance
  • Medicare

Recent Posts

  • S Corp owners and QSEHRA
  • Obamacare at 13: Biden and a KHN Reporter Remember
  • Secure Your Family’s Future with a $50,000 Life Insurance Policy

Newsletter

  • Contact
  • Privacy Policy
  • Terms & Conditions

© 2022 insuremonkey.com - All righst reserved.

No Result
View All Result
  • Home
  • Insurance Education
  • Health Insurance
  • Insurance for Business
  • Life Insurance
  • Casualty Insurance
  • More
    • Health Care
    • Medicare

© 2022 insuremonkey.com - All righst reserved.