Undivided: Frequently Asked Questions about Medi-Cal Managed Care Plans
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Event Recap

How Does Medi-Cal Managed Care Work With Private Insurance?

Published: Jan. 18, 2023Updated: Jan. 18, 2023
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On January 12, we held a live Q&A with Public Benefits Specialist Lisa Concoff Kronbeck to address questions about the recent changes to Medi-Cal. Whether you missed the live event or you want to review what we learned, check out the highlights below!

The #1 thing you need to know about the change from fee-for-service to managed care

In this clip, Lisa lays out what you need to speak with your providers about, and she underlines why documenting medical necessity is so important if you want Medi-Cal to cover a service or prescription:

Troubleshooting your new managed care plan

We’ve been hearing in our Facebook group that the change to a managed care plan isn’t going smoothly for all families. If you have questions about the managed care plan you were assigned, and you’re having trouble reaching a representative over the phone to resolve the issue, check out Lisa’s tips for getting through to Medi-Cal:

Top 3 tips for using Medi-Cal together with your private insurance

Check out this clip for a quick summary of Lisa’s advice for using Medi-Cal coverage to supplement your private insurance:

Keep in mind that the people responsible for processing claims are still learning how this big change is supposed to work. Lisa reminds us that it’s going to take a while to iron out the kinks, so don’t be afraid to use the grievance process in the meantime to clear up misunderstandings and get things covered.

One of the most frequent questions we received during our Q&A event is: Can families who have private insurance still go to any Medi-Cal doctor who takes their plan?

Lisa says that as long as the provider is in-network with the private insurance plan and the managed care plan, Medi-Cal should pick up the out-of-pocket expenses regardless of whether or not the referral was made by a managed care doctor. The same should be true of DME and prescriptions.

For example, if your child needs some equipment and your primary insurance doctor writes a prescription for DME, you should not also need a prescription from a managed care doctor. The primary insurance doctor’s prescription should suffice as long as you purchase the DME from a provider who is in-network for both plans. Similarly, if you need to see a specialist, make sure the specialist is in-network with both plans; you don’t need a referral from a managed care primary doctor. Lisa says that as long as you have private primary insurance, Medi-Cal should not require you to visit a managed care primary physician. If that happens, please let us know.

For more information about using Medi-Cal as secondary coverage, see this article.

Thank you to Lisa for answering questions during our event on January 12, 2023! You can catch the full recording here.

Keep an eye on our Facebook page to learn more about upcoming events, and join our private Facebook group for parents to keep the discussion going!




The #1 thing you need to know about the change from fee-for-service to managed care

Troubleshooting your new managed care plan

Top 3 tips for using Medi-Cal together with your private insurance

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Related Parent Questions

How do I use Medi-Cal to cover medical supplies denied by private insurance?
For supplies that aren’t completely covered by your primary insurance, you will need a written denial from your primary insurance as well as a prescription from your doctor showing that the supplies are medically necessary.
How do I apply for the Medi-Cal institutional deeming waiver?
Once the Regional Center refers your child for Medi-Cal’s HCBS-DD waiver, you will receive a thick packet of paperwork in the mail. Some Regional Centers have a designated Medi-Cal specialist who can set up an appointment with you to help you fill out this paperwork.
What can I do if Medi-Cal denies my claim?
If Medi-Cal denies coverage for something your child needs, you are entitled to an appeal. The appeal process changes depending on whether you are enrolled in a managed care plan or straight Medi-Cal.

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