Friday, November 22, 2013

Chronicling the circles

For the past several days I've been trying to undo a snafu with Maggie's state medi-cal insurance. We do have private insurance for her and the state stuff is secondary. Without this extra layer of protection we could never have kept Maggie at home and healthy.  According to the state websites, anyone with primary coverage is to be exempted from managed care because it won't work as a secondary layer; yet they have her enrolled in a managed care program.

Because it involves the state, I have to deal with a number of different agencies, each pointing to another as the problem. After getting the runaround for days I decided I'm writing to all of the agencies involved, county, state and Feds. (In fairness, this is not the fed problem, but the state is using Social Security in their blame game, so I have to include them in my letter.)

Don't be jealous of my life, but this is how my Friday started. And all it does is chronicle how I spent my Wednesday and Thursday.


November 22, 2013

San Francisco Department of Human Services - Medi-cal
1440 Harrison Street
San Francisco, CA 94103             Medi-Cal ID# XXXXXXXXXXX

San Francisco Health Plan              Member id#XXXXXXXXXXXXX
201 Third Street
San Francisco, CA 94103

Social Security                                  SS# provided only on the Social Security Copy)
90 7TH ST 

RE:  Mary Margaret McDonald
        Disenrolling from Managed care

Please be advised that Mary Margaret McDonald continues to have private insurance and her medi-cal coverage is secondary. Accordingly, she should not be involved in a managed care program.

I have tried to contact each of the above agencies but find myself constantly being referred to one of the others. Both San Francisco Health Plan and Medi-cal advised me to contact Health Care Options. Health Care Options says the social security information does not include the underlying insurance. Social Security says the information is in fact on there and refers me back to medi-cal (note this is really not social security’s issue. It is a California problem.) 

Following each of the instructions was circular and I have not been successful in getting this information to the correct people. The worker at medi-cal arranged to have a supervisor from Health Care Options contact me. I was told to expect the call within 24 hours. It came at 8:30 this morning while I was in the shower. I returned it 15 minutes later and was advised I now have to wait until Monday for another supervisor to contact me. I’m sure you can imagine my frustration. 

I believe that Health Care Options needs to fix this but Mary Margaret need all of you to work together to make this right.  Mary Margaret McDonald should not be a member of the San Francisco Health Plan or any managed health care plan. Having primary insurance is a basis for exemption from managed care.

Her primary insurance is the same as it has been for the past several years. I am providing the information again
Anthem Blue Cross ID# XXXXXXXXXXXX
Member name: XXXXX XXXXXXX (her XXXXX)
Group # XXXXXX

A copy of the front and back of the insurance card is attached AGAIN. Please contact me to advise how to remedy this situation and to disenroll her from managed care


Sara Coghlan McDonald
mother/conservator/designated payee

Don't you love all my titles? 

what did you do this morning?

1 comment:

  1. I, too, was online trying to navigate the individual/family insurance website of Healthnet. Your post about Medi-Cal had made me nervous as I have no idea what kind Sophie has -- Monday will, perhaps, be a day where I commence to figure this out. I wish that we could do shots together through this --


Hi Maggie loves your comments. It may take a while for the comment to post, but you will see it eventually.