ANA Discussion Forum
General Category => Insurance => Topic started by: Pain in the Aspirin on September 15, 2021, 11:37:34 pm
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Hi all:
I am trying to help my girlfriend. She has a 1.4 CM AN tumor that may have to come out. She works hard every day, but she only has Medi-Cal for her Health Insurance which is administered by "L.A. Care" in downtown Los Angeles. Her primary care is "Asian Pacific Heathcare Ventures", also in L.A. Her daughters and I would like to take her to the best, either House Ear Institute or Dr. Friedman at UCSD. However, her Medi-Cal Insurance has declined to pay for an out-of-network doctor. They want to send her to Dr. Bader in Glendale California. I am new with understanding Medi-Cal. How do I appeal the decision of the Insurance? How can I get her covered for the best doctors? Her daugthers are going through the appeal process but it does not look promising. We are trying to get a letter from her Primary Care physician attesting for her need for a great doctor to do AN craniotomy surgery. Should I seek an attorney of some sort? Can you tell me how to succesfully appeal her denial of an out-of-network doctor?
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I see this is an old question but we’re you able to figure this out?
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I'm sorry to hear about your girlfriend's situation. It sounds like you're going through a difficult time trying to navigate the MediCal insurance system.