Where in CA are Medi-Cal specialist appointment wait times longest/shortest? (Santa Clara: gynecologists, health insurance)

[itsacoldplace]

I've seen articles recently about Medi-Cal patients having to travel +3 hours in some cases or wait many months to see specialists. Does anyone have info any particular counties of CA being particularly good or bad in this aspect?

[cb73]

I don't think it's about a particular county being good or bad so much as the reimbursement rate for MediCal is so low (not covering the office's expenses and lab fees, for example) that specialists may look on the appointments as "charity" and only make allow a certain number per month.

[itsacoldplace]

Originally Posted by cb73

I don't think it's about a particular county being good or bad so much as the reimbursement rate for MediCal is so low (not covering the office's expenses and lab fees, for example) that specialists may look on the appointments as "charity" and only make allow a certain number per month.

Yes I understand that that is one of the big reasons for the problem. What I'm looking for is if anyone can give any insight to the geographical variability of access to health care for Medi-Cal patients in California.... specialty care in particular. (Neurologists, gynecologists, etc) Access to care can vary a lot within a state, depending on the location, (rural areas tend to be worse) it seems that California is no exception.

[NoMoreSnowForMe]

I've been on Medi-Cal in three counties in CA now. Santa Clara, Shasta and now Del Norte.

In all three counties my assigned providers have been the county medical centers/clinics. I've found them all to be good. If you go through the county providers, they accept Medi-Cal, so there's no question of providers accepting you.

What I've found happen, is that Social Security gets you in their system in a particular county. Then a provider is assigned to you. When I've had a choice, as I did in Santa Clara County, I chose the county medical center. Then, you contact the county clinic and ask them for an appointment and/or to be assigned a primary care physician. This is where the delay comes in. This can take 6 months. BUT, you can still go to the waiting room and be seen and get your prescriptions filled - you just don't have a PCP yet.

As far as getting referred to specialists - there are different rules. A patient may be required to first allow their PCP to attempt to treat the problem. You have to first be seen by the PCP before you get sent to a specialist.

But, really, this is no different for me than when I had health insurance through Kaiser or Blue Cross. And with Blue Cross, I was always afraid they would decide to reneg on an approval and I'd end up with a bill, which happened. With Medi-Cal through the county systems, you don't have to worry about that. I've found it actually easier to get to a specialist with Medi-Cal than I ever did with private health insurance.

Denti-Cal is another story altogether. It's nearly impossible to find a dentist that will accept Medi-Cal. Even the county dental clinics are not accepting new patients, in my experience in Shasta and Del Norte Counties. I was able to be seen by the dental clinic in Santa Clara County's medical system, but only for emergencies where I was in pain. If they can't pull a tooth, because of a complicated problem (which I had once) they can refer you to a private specialist to pull the tooth. This happened for me. I understand there is more dental coverage now than there was when I first got Medi-Cal in Santa Clara County, but they would pretty much only pull a tooth but not fix it, unless it was a simple cavity. No root canals.

Hope that was helpful. FWIW, I'm happy with the system, except for dental.

Oh, and for vision, we used to only get an eye exam, but the provider for Del Norte County, just added eye glasses every two years. So, I just had my eyes examined and got a new pair of glasses, with no co-pay required.

[itsacoldplace]

That definitely provides some insight into the system. Thank you very much NoMoreSnow... glad you've had an okay experience so far!

[NoMoreSnowForMe]

Oh, I realized I should add, that minors get priority for dental coverage. They would accept me as a new patient, if I was a minor.