I am in the process of looking for insurance. I qualify for medi-cal, which basically free, and thats awesome don't get me wrong, but I really don't want to have coverage thats going to be a pain in the ass, no pun intended. I have just heard that certain things about medi-cal can be not so great, like having certain medications covered, getting in to see a dr, etc. And being that it seems i have been blessed with the need to be at the dr office constantly i really just dont want to have to deal with something thats going to cause me frustration any more than i already deal with on a weekly basis. I had kaiser, and i actually still do, but only through their mfa program till the end of may'16, i could get kaiser again, but i just have issues with their pain mngmnt. To be honest I am leaning toward blue shield, which is what i had last year, and I am just curious for anyones input, especially if you might happen to live in the los angeles area. But i am interested in everyones opinion as I am sure insurance has been something that everyone here has had to deal with in one aspect or another. By the way, kaiser was just conveniently located, like 5 mins from my house.
Medi-cal a bad choice, or better to get a ppo?
- Thread starter BigBoss
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Will do. I can tell you i have had blue shield before, and basically was going to cedar sinai in l.a., ca and that place was amazing, and dr.s were pretty good, hospital stays were freaking amazing, best cleanest hospital i have been in. But my biggest question is just about using medi-cal, for some reason i am hesitant to go that route. Just remeber hearing as long as u dont have to go to the dr too much, its good. But i got to the dr all the time.
I've had kaiser forever and am happy with it.
I've never had medi-cal, but I've heard the same things you have: difficult to find my, difficult to get certain Meds covered, longer waits... Doesn't seem fair/right, but that is what I've heard.
Hopefully someone with experience using medi-cal will chime in...
I've never had medi-cal, but I've heard the same things you have: difficult to find my, difficult to get certain Meds covered, longer waits... Doesn't seem fair/right, but that is what I've heard.
Hopefully someone with experience using medi-cal will chime in...
I've had Medi-Cal since I was diagnosed at age 9, I'm 33 now. I don't think there's any insurance company out there where you won't deal with bull **** from time to time. I've lived in LA county before and there were plenty of doctors to see since it's a large area (UCLA has awesome doctors). Medi-Cal would be a problem in a smaller city with only one or two doctors to choose from but in larger cities I haven't run into that problem.
Pro: It's free health care. All doctor visits, tests and medications are free. They pay for most medications (I had Humira, Remicade, Methotrexate, 6MP, Pentasa, B12 shots etc covered without question). Going to the ER now has a copay of $5 (it used to be free). Tests like blood work, x-rays (along with tests that use a medium etc but are still just an x-ray like a small bowel follow through and sitz marker study etc), EKG etc don't need approval.
Con's: Your general practitioner needs to write a referral to any specialist (GI, cardiologist, rheumatologist, pain management, physical therapy etc all require a referral) and Medi-Cal has to approve it before you're set up with a specialist which can take a couple days to a couple weeks depending on the staff at your GP's office. All referrals expire in 6 months but only take a couple days to renew. Certain tests require approval (MRI, MRE, CT scan, pill cam (I was denied this test because Medi-Cal claimed it was for diagnosis only but I think it could have been covered if my GI had tried harder) bone density, EMG, holter monitor, etc require approval unless you're in the ER then you don't have to wait for approval).
Overall I think it's worth it especially when I hear about all the problems my friends, family and forum members have had with other insurances which usually results in them not being able to pay for the care that they need meaning they go for long periods of time before getting medication, having an important test done or even just going to the doctor. Copays get expensive especially if you go often. Having to wait on occasion for a test or referral to a specialist hasn't been an issue for me especially since you can contact the people who do the referrals and let them know that it's urgent and they will get it done ASAP. I go to the doctor more than once a month and sometimes once a week depending on what I need done. I rarely run into any problems. Also if you don't like your GP then you can ask to see someone else, I've switched many times. If you don't like your specialist then you will need another referral to another one (call around and request a specific doctor when you get a referral once you find one that you may want to see, make sure they accept Medi-Cal, I do this to avoid this issue in the beginning).
Remember that you can always go to the ER if you can't get in to see your GP for any pain or if you need antibiotics etc (basically you don't need to be on the verge of death to go to the ER, I've gone for antibiotics for a very bad tooth ache and had it pulled a couple days later). That reminds me that they brought back Denti-Cal so you can go in for dental work now (for a few years they only covered extractions). They will also cover psychologists and psychiatrists.
If you have any specific questions feel free to ask.
Pro: It's free health care. All doctor visits, tests and medications are free. They pay for most medications (I had Humira, Remicade, Methotrexate, 6MP, Pentasa, B12 shots etc covered without question). Going to the ER now has a copay of $5 (it used to be free). Tests like blood work, x-rays (along with tests that use a medium etc but are still just an x-ray like a small bowel follow through and sitz marker study etc), EKG etc don't need approval.
Con's: Your general practitioner needs to write a referral to any specialist (GI, cardiologist, rheumatologist, pain management, physical therapy etc all require a referral) and Medi-Cal has to approve it before you're set up with a specialist which can take a couple days to a couple weeks depending on the staff at your GP's office. All referrals expire in 6 months but only take a couple days to renew. Certain tests require approval (MRI, MRE, CT scan, pill cam (I was denied this test because Medi-Cal claimed it was for diagnosis only but I think it could have been covered if my GI had tried harder) bone density, EMG, holter monitor, etc require approval unless you're in the ER then you don't have to wait for approval).
Overall I think it's worth it especially when I hear about all the problems my friends, family and forum members have had with other insurances which usually results in them not being able to pay for the care that they need meaning they go for long periods of time before getting medication, having an important test done or even just going to the doctor. Copays get expensive especially if you go often. Having to wait on occasion for a test or referral to a specialist hasn't been an issue for me especially since you can contact the people who do the referrals and let them know that it's urgent and they will get it done ASAP. I go to the doctor more than once a month and sometimes once a week depending on what I need done. I rarely run into any problems. Also if you don't like your GP then you can ask to see someone else, I've switched many times. If you don't like your specialist then you will need another referral to another one (call around and request a specific doctor when you get a referral once you find one that you may want to see, make sure they accept Medi-Cal, I do this to avoid this issue in the beginning).
Remember that you can always go to the ER if you can't get in to see your GP for any pain or if you need antibiotics etc (basically you don't need to be on the verge of death to go to the ER, I've gone for antibiotics for a very bad tooth ache and had it pulled a couple days later). That reminds me that they brought back Denti-Cal so you can go in for dental work now (for a few years they only covered extractions). They will also cover psychologists and psychiatrists.
If you have any specific questions feel free to ask.
Yes. You need a referral to go there though. My last scope was done by Christina Ha in UCLA. It was for a second opinion. You can also go to specialists in Standford and I believe Santa Barbara but I'm not 100% on SB.
