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 still do and always will accept Medi-Cal recipients. Read the below important message:
1. VSP's Medi-Cal through Health Plan of San Joaquin
2 Health Net's Envolve.
3. "straight" Medi-Cal
We still do and always will accept Medi-Cal recipients. Read the below important message:
We offer specialized services, above-standard care and beyond insurance requirements. As example:
1. A comprehensive exam includes 13 procedures while Medi-Cal only offers 6. Specialized)includes 21. Medi-Cal does not allow a specialized exam because it evaluates services they do not cover like vision therapy.
2. Specialized eyeglasses services include customization to the shape of your head, Medi-Cal does not cover customizing only selecting the fit and dispensing in a case.
All the specialized services are covered in full or part by insurance. VSP, Medicare, and VA are examples.
For decades we offered some Specialized services to Medi-Cal patients. However, the current governor did not raise Medi-Cal fees but cut them. We can’t continue extra Specialized services. Thus, to some, it will appear we are reducing your benefits. No, we are no longer able to offer the extra non-covered specialized services.
As always, Medi-Cal allows you to pay for non-covered services. You always paid for transition lenses, up-graded frames, binocular vision diagnostic testing, light therapy, and vision therapy. You still can.
Should you wish a Specialized exam, you may do so for a $30.00 fee.
Should you wish Specialized eyeglasses services, you may do so for a $30.00 fee.
1. A comprehensive exam includes 13 procedures while Medi-Cal only offers 6. Specialized)includes 21. Medi-Cal does not allow a specialized exam because it evaluates services they do not cover like vision therapy.
2. Specialized eyeglasses services include customization to the shape of your head, Medi-Cal does not cover customizing only selecting the fit and dispensing in a case.
All the specialized services are covered in full or part by insurance. VSP, Medicare, and VA are examples.
For decades we offered some Specialized services to Medi-Cal patients. However, the current governor did not raise Medi-Cal fees but cut them. We can’t continue extra Specialized services. Thus, to some, it will appear we are reducing your benefits. No, we are no longer able to offer the extra non-covered specialized services.
As always, Medi-Cal allows you to pay for non-covered services. You always paid for transition lenses, up-graded frames, binocular vision diagnostic testing, light therapy, and vision therapy. You still can.
Should you wish a Specialized exam, you may do so for a $30.00 fee.
Should you wish Specialized eyeglasses services, you may do so for a $30.00 fee.
To Our Medi-Cal patients:
Yes, we do provide services for Medi-Cal recipients. However, we must comply with onerous strict Medi-Cal policies. Again I say, we accept Medi-Cal and must follow their rules. Those policies do not necessarily reflect our policies and oft don't. You will find your vision exam is equal or of higher quality than any other you have had.
Our private pay and insurance coverage patients are not subject to those regulations. Thus, it may appear we are treating you differently. No, we are treating you according to Medi-Cal regulations. You are limited to Medi-Cal services always different than private pay and insurance. As an example, the cost of eyeglasses provided and lens options are minimal. However, those services are free to you. Treatment options are dramatically reduced. Yes, you have a perfect right to pay for any services Medi-Cal does not cover.
Here are our policies that resulted from Medi-Cal regulations:
1. Only one family member per day is to be seen.
2. Only one service per day is allowed(the same is for Medicare)
3. Only the patient and one parent are to appear (an interpreter may appear also).
4. The parent and interpreter are to accompany the patient in each room, not remain in the reception room.
5. All eyeglasses are ordered from the state lab., which takes a minimum of two weeks. We highly advise a second pair. We even have a Value Plan to help your finances.
6. It is illegal for us to apply the unused Medi-Cal frame value toward the purchase of a private pay frame. We do have a Value Plan available The value plan is a greater value than if we applied the unused fame value!.
7. Medi-Cal lost or broken glasses replacements are at no cost but require a signed form. After the first loss, replacement is up to Medi-Cal review.
8. Broken or lost glasses will be placed in a queue with all of the day's services, not acted upon immediately.
Yes, we do provide services for Medi-Cal recipients. However, we must comply with onerous strict Medi-Cal policies. Again I say, we accept Medi-Cal and must follow their rules. Those policies do not necessarily reflect our policies and oft don't. You will find your vision exam is equal or of higher quality than any other you have had.
Our private pay and insurance coverage patients are not subject to those regulations. Thus, it may appear we are treating you differently. No, we are treating you according to Medi-Cal regulations. You are limited to Medi-Cal services always different than private pay and insurance. As an example, the cost of eyeglasses provided and lens options are minimal. However, those services are free to you. Treatment options are dramatically reduced. Yes, you have a perfect right to pay for any services Medi-Cal does not cover.
Here are our policies that resulted from Medi-Cal regulations:
1. Only one family member per day is to be seen.
2. Only one service per day is allowed(the same is for Medicare)
3. Only the patient and one parent are to appear (an interpreter may appear also).
4. The parent and interpreter are to accompany the patient in each room, not remain in the reception room.
5. All eyeglasses are ordered from the state lab., which takes a minimum of two weeks. We highly advise a second pair. We even have a Value Plan to help your finances.
6. It is illegal for us to apply the unused Medi-Cal frame value toward the purchase of a private pay frame. We do have a Value Plan available The value plan is a greater value than if we applied the unused fame value!.
7. Medi-Cal lost or broken glasses replacements are at no cost but require a signed form. After the first loss, replacement is up to Medi-Cal review.
8. Broken or lost glasses will be placed in a queue with all of the day's services, not acted upon immediately.
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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 one 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 one 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.
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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. We can not repair glasses. It is too costly. They will be re-ordered.
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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.
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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.
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Yet, we always must question if we can continue on this seemingly impossible road.