Author Topic: California Medi-Cal insurance won't allow UCSD or House Ear, how do I appeal?  (Read 4517 times)

Pain in the Aspirin

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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?   

kcollette

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

DavyBlaid

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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.