The 'poor' Denied another service

I am 'poor' being on CalOPTIMA (California's form of 'Medicaid). But I do pay my bills, I have a little job and can eat, So I'm being both literal and facetious.

As of July 1st, My kind of people (Medicaid recipients) will no longer be able to get Dental, Optemetric, Podiatric or psych, speech et al in the Medi-Cal System.

I saw my dentist this last month, I have new glasses from April. but as a PWD, the podiatrist is a necessary part of my care. I think I'm a tad frightened.

Other news and the Denial:
My Horizon Fitness Elliptical is being delivered and set up for me tomorrow. I'd ordered it and have to get it built and delivered for me - safer for me with my eyes, I didn't want to chance trying to build the thing :-)

Some good;
Recently, I changed networks within the CalOPTIMA system, from United Care Medical Group, to Monarch Health care.

Labs, Internist and Endo are MUCH more convenient to get to!! I feel like having been reborn, actually. This has been a MAJOR plus in the change to Monarch.

Monarch even has a 'management nurse' who is in constant contact with me, at least every 2 weeks. She has been the best 'friend' you could ever have in the system. She's like so dang nice and is willing to help me get things I need.

The 'Bad';
She knew of a GREAT CDE/RD who she felt I could benefit from seeing, so she gave me the number, and then 2 days later, an approval came in the mail for me to see this fine lady. Tammy Boico, RD/CDE is out at Saddleback medical center, and is a certified pump trainer, dietitian, and Diabetes Educator, her husband and 2 daughters are IDDMs and on the pump as well! After the initial visits, she does communicate through email, so we both thought "COOL!" I got the bus route all planned out to get there and to see Tammy Boico. I was incredibly happy to think I'd get the treatment I'd heard of others getting.

I then called the center to make the first of 4 approved appointments and was crestfallen to hear that they do not accept CalOPTIMA patients :-( Well, excuse me!

Zoraida (the management nurse) is seeking out other options, but she even sounded a bit disgusted and let down as I was. It isn't like Ms. Boico would have had to work all that hard with me. I'm not 'new', I know a lot of this stuff, I have a Pump and CGMS and work DANG hard, so I guess I'd had hopes for the 'premium package'- so to speak.

Back I am with Twitter-diabetic online community, TuDiabetes & Insulin-pumpers.

Another 'wee nudge';
SSI sent me a love letter I got today saying my monthly SSI of normally $198 is being cut to $175 because California has no money. Greeeeaaaaatttttt. I'll hopefully get more hours at my P/T work. Cut backs all over won't make it easy, but I try anyway.

At least after the elliptical gets here, I'll work off some of the gluco-pixies.

Jenny

Views: 131

Tags: CDE, CalOPTIMA, Medicaid, exercise

Comment by Karen on June 7, 2009 at 7:34pm
I just thought I'd drop in and give you a link to CalOptima's website which is not too bad. I had an excellent doctor at Chapman in Orange when I lived in OC and I know he accepted CalOptima members at that time. This was over 10 years ago though so. Sorry your provider of choice isn't on the CalOptima plan, but there are some excellent ones that are. I'm so very impressed that you have a pump and a CGMS with CalOptima, that is excellent news to me!! Here's that link: http://www.caloptima.org/member.htm
Comment by Jenny on June 7, 2009 at 9:24pm
Actually I am on CalOPTIMA and Monarch is in the CalOPTIMA service. Monarch is a benefits driven provider. So CalOPTIMA says no to dental, for example, Monarch would also have to say no. I pay for my sensors OOP, but the pump supplies and all are usually covered.

This will be my first pump supply order with Monarch/CalOPTIMA, so I'm a bit nervous. Talking to Zoraida, she confirmed dental, eyeglasses and podiatry will no longer be covered. That, IMO is 'false economy'. We'll see in July and hope this does not last long at all.

Hopefully, the ER costs and such will make them think twice very soon.
Comment by Jenny on June 7, 2009 at 9:26pm
BTW, the endo I think you may be speaking of is Dr. Herbert Rettinger. He no longer accepts CalOPTIMA patients at all. They quit back in October.
Comment by Karen on June 8, 2009 at 9:29am
Sadly, more and more providers will be dropping out of the network plans I suspect, and more and more members will be dropping in. That is not the doc I was referring to, and the link I sent lists the plans as well as the providers for those plans.
Comment by Jenny on June 8, 2009 at 9:41am
I know, but as you say, many of them have left. My favourite practice was Dr. Mayeda w/ Peggy DelMastro CDE. They are on LeVeda in Orange across form St. Joe's. They stopped CalOPTIMA About 7 years ago. Peggy's moved on to work in Oncology at St. Joseph's hospital

Now, I am seeing Marshall Grossman in Irvine. He's a very good 'scientist'.

My plan is what I get for being an SSI recipient. I'm under 55, so it isn't One Care and I'm not a Gov. Employee with it.

Not sure what you might think I've missed here... I'm at the CalOPTIMA site frequently, and they are the ones who recommended Monarch when UCMG has their doctors etc all so very far away from me. I'm in Costa Mesa, don't drive, and all their things were out in W. Anaheim, Westminster and points north. CalOPTIMA let me change to Monarch early outside of their usual times to change because otherwise, I'd be without care frankly. IMO, a 3-4 hr commute to see a doc is unreasonable in this area, day and age.
Comment by Jenny on June 8, 2009 at 7:13pm
UPDATE... UPDATE... UPDATE

My case management nurse called me today, and outside of my insurance, there is a way we can work it so I can see Tammy!! I will see her once or twice, but the rest will be via email. YAY!!!

Very cool!!
Comment by MomsL8 on June 9, 2009 at 1:44am
Wow - that truly does suck! Glad they are seeing the "human" side of the issue and trying to work things out for you!

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