The new wave in healthcare … the old bait and switch!

In the the article on August 16th: “State cuts in care for poor to begin” Chris Megerian speaks of the problems that will inevitably effect ALL Medi-Cal recipients.
It is a timely article but neglects to tell people that these draconian cuts are ALREADY having an effect.

In the article Megerian speaks about the potential cuts to Medi-Cal and the ultimate results that will negatively impact those who receive benefits. What is not made clear is the fact that doctors AND dentists are ALREADY making a mass exodus from ANY plan that pays the new state rates of reimbursement.

I am a survivor of hurricane Sandy and lost virtually everything. I was forced to relocate to LA because there was no affordable housing available in the area effected by the storm. I was going to make the move in the future anyway because most of m family is in LA but Sandy made the immediate decision for me.

I applied for Medi-Cal because it would allow me to get needed coverage while my living situation stabilized. In June I was informed that Medicare would pick up my coverage and I was eligible for a “Medicare Advantage” plan with help from the State of California.

I did my research and chose a plan that seemed to cover what I needed and met with the plan representative to sign up and choose my “primary care practitioners.”
I chose a doctor (whom I LOVE) and a dentist (again a great choice) and signed on. That was in the beginning of June with the plan becoming effective as of July 1st.

At my meeting with the plan’s rep., I was given two lists. One was a list of participating physicians and one a list of dentists all of whom accepted the plan; I made my choices from these lists. The lists bore the titles ‘Participating Physicians” and “Participating Dentists” and both were dated 2013.

What they didn’t tell me was that for THIS plan … 2013 ENDED ON SEPTEMBER 1st!

About a month later in July, and after my visit to my chosen new dentist, I received a new membership card and a letter from Liberty Dental (the plans’ dental affiliate) telling me that I had been ASSIGNED yet another NEW dentist and, as of September 1st, I MUST go to that new dentist in order to be covered.

I called Liberty and questioned why this was being done because (1) I liked the dentist I had chosen and (2) the dental facility that I had been assigned to was one I would NEVER use. I was told that as of September 1st my choice would no longer participate in the plan. So we stayed on the phone for almost an hour trying to find a dentist that would still be on their rolls after September 1st and found that, with the exception of very few dental facilities, about roughly 80% of the dentists were leaving the plan; so my “choices” were limited to the ones that were left. There were 3 within 10 miles of where I live (and I live in downtown LA).

My situation was further exacerbated by the fact that the dentist I had chosen had submitted a treatment plan to Liberty Dental for approval on July 9th and somehow (?) Liberty had “never received” the proposed treatment plan. The dental office, now fighting the September 1st doomsday deadline, resubmitted the plan on August 2nd and again about a week later; but Liberty still does not have a record of the plan. My guess is that they are waiting for doomsday by avoiding the claim entirely.

What Liberty Dental is essentially doing is suspending an existing plan that actually offered real dental coverage (the plan I signed up for) and instituting a system where they will now act as a “plan manager” and pass on ALL costs to Medi-Cal if the member is even remotely covered by Medi-Cal in any way. This is something, that, if they are allowed to do it, will significantly boost their bottom line.

There was no other notification of this change given to the people who rely on this plan for their health and dental care.

The result is that those covered are left with NO choices at all when it comes to providers and makes the plan an extension of the soon to be reduced Medi-Cal system.

The plan I signed up for is a MEDICARE ADVANTAGE plan; it is not Medi-Cal. The premium ($104 a month) is paid through the State of California but the benefits are sourced through Medicare NOT Medi-Cal.

After hours on the phone and internet sites trying to solve the problem, with NO help from the plan; I eventually, in frustration, I called Medicare.

I explained everything. I told the Medicare Phone Representative what had happened. I told him that I felt I had been a victim of a medical/dental “bait and switch” scam. I asked, no I actually begged, to be able to switch to a different plan, even though it was not the “open enrollment period.” After hearing my impassioned narrative; Medicare AGREED! Yes, it was a “bait and switch” and, even better, yes, I could switch plans. Instead of having to wait till January 1st, 2014; I made the switch immediately, right on the phone with Medicare.

I see articles in the LA Times just about everyday telling us that people are “in the dark” about plans and coverage. We are only “in the dark” because the system is deliberately pulling the wool over our eyes.