We are one of the few offices that participate with Medi-Cal (Medicaid) through:
1. VSP's Medi-Cal through Health Plan of San Joaquin
2 Health Net's Envolve.
3. "straight" Medi-Cal
We are one of the few offices that participate with Medi-Cal (Medicaid) through:
1. VSP's Medi-Cal through Health Plan of San Joaquin
2 Health Net's Envolve.
3. "straight" Medi-Cal
To Our Most welcome Medi-Cal patients:
Some of you have complained about your frequency of visits. Please note. Again I say: PLEASE NOTE: We gladly accept Medi-Cal recipients. BUT we must adhere to Medi-Cal strict policies. Those policies do not necessarily reflect our policies.
Both Medi-Cal (Medicaid in CA) and Medicare are administrated by CMS. They allow ONLY ONE SERVICE PER VISIT. Yes, on many occasions we could easily provide more than one service and are allowed to do for private patients.
We have, against advice, included Medi-Cal coverage. Kindly respect our dedication and realize we must adhere to CMS guidelines.
Some of you have complained about your frequency of visits. Please note. Again I say: PLEASE NOTE: We gladly accept Medi-Cal recipients. BUT we must adhere to Medi-Cal strict policies. Those policies do not necessarily reflect our policies.
Both Medi-Cal (Medicaid in CA) and Medicare are administrated by CMS. They allow ONLY ONE SERVICE PER VISIT. Yes, on many occasions we could easily provide more than one service and are allowed to do for private patients.
We have, against advice, included Medi-Cal coverage. Kindly respect our dedication and realize we must adhere to CMS guidelines.
Yes, eyeglasses are now a benefit for adult patients! Department of Healthcare Services Medi-Cal announced optician services are restored as Medi-Cal Benefits for adults. Effective on or after January 1, 2020, optician services (eyeglasses) previously eliminated (2009)are reinstated as Medi-Cal benefits for Medi-Cal recipients 21 years of age or older. Younger ages never lost the service.
|
However, the governor did not increase the optical lab production housed in our prison system. It could not keep up with the sudden demand for adult eyeglasses. We did all we could to motivate the lab with delayed orders for up to 3 months. They finally listened! Turnaround times are closer to two weeks.
We have to follow Medi-Cal regulations and Glasses must be ordered from the state lab. The prior lengthy delays had nothing to do with us. There is one thing you can still do. All of us need more than one pair of glasses in case of breakage. Our labs are on schedule(within 10 days). We highly advise a second pair. We even have a value plan to help your finances, where you can get an entire pair of quality glasses at a large discount. |
CAN DOCS AFFORD TO TREAT MEDI-CAL RECIPIENTS?
The Sacramento Bee Sunday, June 4 edition ran a full-page article by Maya Miller entitled,” Out of Sight” with the subtitle “Medi-Cal doesn’t pay enough, eye doctors must turn away patients.” She chose the UC Davis Eye Clinic treating the extremely rare keratoconus. Whether a recipient's care is simple or complicated, CA promises are undeliverable. Dr. Henshaw is of the few local optometrists who treat Medi-Cal patients. We only receive 10% of our normal fee when treating keratoconus. The fee is less than our out-of-pocket lab fee for the lenses alone. No doc can afford to treat keratoconus under the Medi-Cal program.
The Sacramento Bee Sunday, June 4 edition ran a full-page article by Maya Miller entitled,” Out of Sight” with the subtitle “Medi-Cal doesn’t pay enough, eye doctors must turn away patients.” She chose the UC Davis Eye Clinic treating the extremely rare keratoconus. Whether a recipient's care is simple or complicated, CA promises are undeliverable. Dr. Henshaw is of the few local optometrists who treat Medi-Cal patients. We only receive 10% of our normal fee when treating keratoconus. The fee is less than our out-of-pocket lab fee for the lenses alone. No doc can afford to treat keratoconus under the Medi-Cal program.
CA rules for eye docs seeing Medi-Call patients are full of impossible regulations. While admonishing us to give the same care as private patients, they restrict many treatments. We must endure numerous broken appointments while answering unfounded complaints.
|
|
We must supply frames and cases but are paid 30% of the cost. That lower fee for the frames brings less quality making them break more often, difficult to adjust, and need more repair and maintenance. The good news for recipients is that lost and broken glasses are replaced. We order all glasses from the state prison system lab. Yes, it saves us a lab bill; but we are subject to the whims of a bureaucracy. At one point delivery of glasses took three months. Then we struggled with backorders and justifiable complaints from patients. We must supply broken lost/glasses, but aren't assured of payment. CA law requires strong polycarbonate lenses for all, but Medi-Cal only gives them to kids.
|
Medi-Cal pays less than 25% of our exam fee. We are only able to provide one service per day decreasing our efficiency and patient convenience. Then the patients complain and blame us. Billing is tedious, full of mistakes, and has lengthy appeals.
There was a saving grace when three years ago portions of Prop 56 proceeds (the cigarette tax) were shared with Medi-Cal providers. Yet, the Governor diverted the funds this year.
|
That’s the negative part and plenty of it, but we have come up with solutions to serve our Medi-Cal recipients. We use careful purchasing, electronic paperwork and billing, and discovered the most common services. We also work closely with those running the Medi-Cal programs with polite friendly interactions.
|
|
Yet, we always must question if we can continue on this seemingly impossible road.