Monday, August 10, 2009

My Experience with State Run Health Insurance:Medi Cal

I have spent the last thirteen months of my daughter's life trying to get health insurance for my family. We lost our insurance four weeks after my daughter was born and paid out of pocket for her appointments and vaccines. It drained our savings pretty quickly.

I had heard wonderful things about California's Healthy Families Program. Our doctor accepted the insurance and said that the coverage was great. So we applied and waited... and waited... Months passed. Finally we got a letter that said that we didn't make enough money to qualify for Healthy Families. They were forwarding our application to Health and Human Services because we may qualify for Medi-Cal (one would hope that if we didn't make enough for one type we would qualify for the other... imagine hearing, you don't make enough for a type of public assistance... it defies logic!).

Thus we began to deal with the bureaucracy put in place by the great State of California to ensure the well being of its citizens. In September we received a giant packet of paperwork that needed to be returned immediately. I rushed to make copies of pay stubs and bank statements, loan statements and car bills. Our income had fallen from $26,000 a year to $12,000 a year. I was sure we would qualify. I returned the packet.

December came and we hadn't heard anything back from HHS. I went to the office to see what I could find out and was told to call my social worker. When I said we hadn't been told we had a social worker I was given a name and a number. I called and the phone rang through to voice mail. The message told me what information I should leave and then informed me not to call back. My case worker would respond in writing or over the phone.

A month passed with no call (we had now been waiting for five months). I went back to the office. I was told to call my social worker. I bit my tongue hard to keep from yelling (I was very frustrated and had no idea that the waiting was just beginning). I said I'd called a month earlier and that I hadn't heard anything. I was given a piece of paper to write a note on and handed it back, filled out, under the bullet proof glass. I now understood why it was there. This process could drive someone crazy.

Two weeks later a friend of my father who worked in the office of HHS told me to call to speak with her. I explained what had gone on and she was horrified. She told me that she would transfer me to the case worker and that I should say that if I didn't hear from her I would call back and ask to speak to her supervisor. I received a call an hour later from our apologetic case worker. She had been out of the office for a while and things had piled up. She was very sorry. She would send another packet with more paperwork for us to fill out.

I got the packet, with a list of included forms. They weren't all there. I filled out what I had and went down to the office. I showed the list and asked if I could get the forms or if I could speak to my Social Worker. I was told that she wasn't picking up her phone, and they didn't know which forms were on the paper I'd showed, so I could, you guessed it, leave her a note. At this point I nearly lost it. I refused to leave. My voice got louder. I was holding my eight month old daughter and had spent most of her life trying to get someone in this office to call me back. No one would call if I left. I was told to sit down. Amazingly, someone found the forms. I filled them out and turned them back in.

This spring our application was denied. We had $1000 too much in savings when we applied, but if we could prove that we had spent that much on medical bills we would qualify and our application would be reprocessed. I scrambled around the house. I easily found more then a thousand dollars in bills. I took them in to the HHS office. And waited.

The next letter that came claimed that I had never turned in my husband's pay stubs for the month of November. I had, but apparently they were no longer with our file. The letter said that if the office didn't receive copies of the stub by the next day, our application would be denied. I drove down to my parents storage locker and ripped apart our belongings until I found a box with last years pay stubs (when you live in a 10x15 ft cabin there's not a lot of room for storage). I found them and we took them to the office the next day. My husband said he would take them in because he was afraid I might snap if I went in.

This July, 11 months after our application arrived at HHS, we received a letter saying we had been denied. It explained again that we had too much in savings, but that if our savings had been drained by medical expenses, we could reapply.

I didn't take more copies of the bills in, because I didn't trust myself to explain that we had already given them over a thousand dollars in medical bills, without bursting into tears in the middle if the office.

Today my husband went into the office. He says he just acts like a big dumb guy and everyone is helpful (and a little flirty). They gave him papers to fill our and had him watch a movie about all the services they offer. Then they interviewed him and set up another interview for Wednesday morning. I need to fill out all the paperwork again and get together all the various statements to take in. It seems that things might finally be going somewhere.

Still, I'm afraid to get my hopes up... I have lost all faith in our state's health system. And I see no reason to believe the federal government would do any better...


  1. That is horrific, and I am so sorry for what your family has gone through and is still going through. How anyone could think that our governments (state or federal) can do any better than private insurance and medicine is beyond me.

  2. Wow! Sounds very frustrating!

    I'm not too happy with insurance around here either. I'm self employed so I don't make much, and obviously have to find my own insurance. Unfortunately for me, here in WI I don't qualify for state insurance because it's only for those with families. So I now have a private insurance with a ridiculously high deductible. I just hope I don't get seriously ill or hurt. So I know where you're coming from.

    Unfortunately I too don't have a whole lot of hope in the federal government will do much better either. I personally believe that they're too influenced by groups with money and influence, so it's hard for the government to have the individual person's benefit in mind..

  3. Do you have a Catholic Social Services health clinic in your area? We had a lapse in our health coverage so I went to the CSS clinic and came away very impressed. They will see you if you don't have insurance and work with the state to get you covered by them if you qualify. They worked with the government for me to get me approved for state insurance (which I only qualified for because I'm pregnant) and provided top notch care for my children and myself.
    We live in Arizona, though, so things might different for you. Good Luck!


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