Friday, September 11, 2009

A Bunch of Emails This Week...

I am putting this up not necessarily to present this particular problem but to illustrate the degree of understandable misunderstanding and complexity surrounding public and private disability benefits.

The first has to do with Medi-Cal and private insurance coverage:

You helped me before with my questions. Originally, ____________ referred me to you. My son receives a stipend from the State, is on Medi-Cal, and also is on my husband's private insurance policy. My son was diagnosed when he was 14 yrs of age, and I was told this would be acceptable to have both insurances when he became 18 yrs of age.
I did not receive any counseling when _______ started to receive the benefits from the State of California. My BIG WORRY, is having the two insurance plans in regards to his controlled medications. The simpliest way for him to obtain his controlled substance meds is to go to the local pharmacy and use his Medi-Cal card. If he had to use my husband's insurance, he would have to pay for the entire medication request up front (which could be thousands of dollars) and then fill out paperwork for a partial refund in 2 to 3 months.
Is Medi-Cal the primary provider? If not, what should I do immediately to rectify this situation?
Last Thursday, September 3rd, my son received a call from Medi-Cal. This lady was asking one answer questions of which he could not remember anything about the call. I did talk to her briefly asking her who she was, because he was on the telephone for such a long time. She said that she was trying to help my son, but I don't know.

Most Sincerely,

My Response:

Actually, Medi-Cal is always the payer of last resort and I suspect Medi-Cal is paying the co-pays that he would otherwise be charged.
I also suspect - although I have no way of knowing for sure - that the call was a redetermination interview because, if he is 18, he is transitioning from youth to adult status. I don't know what category of Medi-Cal he has so I can't say whether it will continue or not.

You said he began receiving his "stipend from Medi-Cal." Medi-Cal is only healthcare coverage and I have never heard of a consumer receiving money from Medi-Cal. It is more likely he is receiving Social Security's Supplemental Security income (SSI) or Social Security Disability Insurance (SSDI). Could you tell me what day of the month he receives this income. This will help me determine the source. The source is important because if it is SSI he has -- and will have -- Medi-Cal until he no longer receives SSI. Actually, the same may applies if he is receiving SSDI but that would involve additional qualifiers.
Again, I suspect they were simply following up to verify coverage and contact information but, until we can speak to someone there we can't be certain.
And until I know what the source of his income is I don't know which approach to take.
I know it is complicated but we'll get it sorted out.

It turns out that the consumer does receive SSI which means he will have No Share of Cost Medi-Cal for the duration of his disability... as long as he receives even $1 of SSI.

There is no restricition on the number of policies that provide healthcare coverage to an individual. It is a great irony in this country that some people are covered by as many as five different policies AND Medicare and Medi-Cal and so many have nothing.

I've often thought it would be interesting that all of us single people should be able to include one other indivdiual (and family,if applicable)on our Health Care Coverage as though we WERE married. Think how many people would then be covered as the "spouse" and "dependants" of the policy holder...

Food for thought.


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