Common Exclusions from Medi-Cal Plans
Many health insurance plans have common exclusions, which means that services and procedures that are not considered medically necessary may not be covered. This can leave a consumer in a financial bind when a health emergency occurs.
One of the most common exclusions is cosmetic treatment. Almost all cosmetic surgeries and procedures are not considered medically necessary. Instead, the patient is required to pay the entire cost.
Another common exclusion is travel costs. For example, a health plan can’t cover a taxi ride to the doctor’s office. Also, some health plans limit the number of visits a patient can make to a provider for coverage.
Pre-existing conditions are also an exclusion. When a person buys a health plan, they must declare any pre-existing medical conditions. These include illnesses or injuries that occurred before the plan’s effective date. Depending on the condition, a person may have to wait up to four years before being eligible for Medi-Cal coverage.
The cost-sharing maximum is the maximum amount the insured will have to pay during the policy period. Typically, this is a year. The insured is responsible for the rest of the cost if the maximum is reached.
Some plans offer a wellness benefit that covers certain vaccinations and health check-ups. However, some plans do not cover dental or maternity expenses.
To determine what is covered, read the policy document carefully. Also, check with your insurer to see any specific exclusions. By doing so, you can be sure to know what is covered and what is not. Otherwise, when a medical crisis arises, you could find yourself with an incredibly expensive medical bill.
Medical Supplies and Equipment
One of the most confusing parts of Medicaid coverage is the definition of medical supplies, equipment, and appliances. The Centers for Medicare and Medicaid Services (CMS) is attempting to clarify its coverage standards by releasing new guidance. Its main focus is the standard for stand-alone home health services, but there are also provisions for non-institutional care. For example, wheelchairs and wheelchair ramps would be covered.
While there is no federal standard for medical equipment and appliances, numerous state laws dictate the types of items that qualify for reimbursement. A handful of states require that items be used as part of a formal plan of care. Others have presumptions regarding the equivalence of certain items. Finally, some states require the use of the best possible standardized documentation.
In the end, the individual state will determine the best way to provide a person with the ability to stay at home for a long period of time. Some states will likely be forced to slash their budgets, while others may opt to cover some items and exclude others. As such, the decision is a delicate one. Those states that do not slash costs will have to offer their residents more than just the basics.
Adults can now apply for Medi-Cal coverage if their annual income is at or below 138% of the Federal Poverty Level. Children and pregnant women can also apply for coverage. In addition, children in foster care can apply. People with disabilities can also qualify for coverage. Individuals can visit their local county social services office for information on applying.
They can also visit the Medi-Cal website to learn more about the application process. A benefits planner can help you determine whether you are eligible for coverage.
File a Claim
When it comes to insurance, timely filing is the way to go. This can be as simple as filing a claim to maximize your Medi-Cal coverage. If all information is available electronically, your coverage may be renewed automatically. However, if you do not have access to an electronic medical record, you will need to provide paper documents to verify your information.
The first step to filing a claim to maximize your Medi-Cal benefits is to find out if you are eligible. You may be able to get a better idea of your eligibility by reading the benefits brochure or talking to a county eligibility worker. Eligibility is based on your income and property.
The best part is that you don’t have to sign up for Medi-Cal to be eligible. Once you qualify, you will receive a Benefits Identification Card (BIC) in the mail. It is a plastic card with a blue strip on the front.
Find a Medical Supply Store that Takes Medi-Cal
If you’re a Medi-Cal beneficiary, you can get a wide variety of medical supplies. However, not all stores accept Medicaid. You should look for a store that offers what you need and can also accept your plan. Also, check to see if the provider can bill you for an appointment.
You can also call a local medical supply store to compare prices and services. They may even offer a limited warranty. You can find a list of stores in your area online. Before you go to a store, make sure to bring your Medicaid card so they can check your eligibility. Some stores can offer discounts on certain items, so be sure to ask before you purchase.
Lastly, if you’re a Medi-Cal beneficiary, consider getting a free emergency supply. Many pharmacies will provide this. Make sure you show your Medicare or Medicaid card to your provider before getting a test or prescription. You can also ask for a form to authorize a pharmacy to sell you brand-name drugs. This is to ensure that the drug is covered.