Medi-Cal Benefits Insurance Companies Are Required to Cover
Medi-Cal is California’s Medicaid healthcare program. As such, Medi-Cal pays for a wide range of medical services for low-income children and adults in California, as well as people who are 65 or older, blind, disabled, under 21, pregnant, in a skilled nursing home or intermediate care home, a parent or caretaker relative of an age-eligible child, been screened for breast or cervical cancer, or are on refugee status for a limited period, depending on the length of your stay in the U.S. Needless to say, Medi-Cal covers a lot of people in California, nearly 15 million as of 2024. That’s nearly one-third of the state’s population.
Medi-Cal doesn’t provide all this coverage on its own. Instead, the state contracts with numerous health insurance companies to provide Medi-Cal coverage along the lines of a typical health insurance policy. Leading Medi-Cal insurers include names you are familiar with, such as Anthem through its Anthem Blue Cross Partnership Plan, Blue Shield of California through its Promise Health Plan, Health Net, Molina and others.
Unfortunately, persons receiving Medi-Cal still face the same challenges getting insurance claims approved and paid as others with private or employer-sponsored plans. Medi-Cal recipients may be entitled to medical services as a matter of law, but that doesn’t stop major health insurers from denying claims by alleging services or procedures are “experimental,” “investigational,” or “not medically necessary.”
Medi-Cal is intended to serve our state’s most vulnerable population. For Medi-Cal beneficiaries in particular, legal assistance is critical to ensuring they get the medical care they need and are entitled to when facing challenges or disputes with their insurance company. As a California insurance bad faith law firm, Gianelli & Morris is committed to helping people on Medi-Cal when they are being treated unfairly by their insurance company, often in direct violation of California law. Here is a look at some of the services and benefits Medi-Cal recipients are entitled to receive.
Essential Health Benefits Through Medi-Cal
In Medi-Cal terminology, Medi-Cal provides Essential Health Benefits. Generally speaking, Essential Health Benefits include the following:
- Outpatient services, such as a checkup at a doctor’s office
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health services
- Substance use disorder services, such as treatment for drug or alcohol addiction
- Prescription drugs
- Laboratory services, such as blood tests
- Programs such as physical therapy (called rehabilitative and habilitative services) and medical supplies and devices such as wheelchairs and oxygen tanks
- Preventive and wellness services
- Chronic disease management
- Children’s (pediatric) services, including oral and vision care
- In-home care and other long-term services and supports
In addition to the above-listed general medical services, Medi-Cal covers dental services; early and periodic screening, diagnostic and treatment; specialty mental health services; inpatient and outpatient substance use disorder programs; and transportation services to access all of the above, as well as picking up prescriptions or medical supplies or equipment.
Get Help With Bad Faith Insurance Denials in California
If you are unsure about whether a particular service is covered by Medi-Cal, your healthcare provider is a good first resource. If they regularly provide care to Medi-Cal recipients, they should have a good handle on what is and isn’t covered, since they bill Medi-Cal and deal with claims reimbursements on a daily basis. If your doctor is recommending a particular service or procedure and your insurer is claiming it isn’t covered, contact our office at 213-489-1600 for a no-cost consultation. If your insurance company is acting in bad faith, we have the skills, resources, and commitment to make sure you get the healthcare you need and are entitled to.
