Changes to Medi-Cal: How Does Managed Care Work With 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! 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!