ANA Discussion Forum

General Category => Insurance => Topic started by: Pain in the Aspirin on September 15, 2021, 11:37:34 pm

Title: California Medi-Cal insurance won't allow UCSD or House Ear, how do I appeal?
Post by: Pain in the Aspirin on September 15, 2021, 11:37:34 pm

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?   

Title: Re: California Medi-Cal insurance won't allow UCSD or House Ear, how do I appeal?
Post by: kcollette on February 07, 2022, 10:37:56 am

I see this is an old question but we’re you able to figure this out?

Title: Re: California Medi-Cal insurance won't allow UCSD or House Ear, how do I appeal?
Post by: DavyBlaid on January 16, 2023, 12:50:29 pm

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.