Hi all:
I am trying to help my girlfriend. She has a 1.4 CM AN tumor that may have to come out. She works hard every day, but she only has Medi-Cal for her Health Insurance which is administered by "L.A. Care" in downtown Los Angeles. Her primary care is "Asian Pacific Heathcare Ventures", also in L.A. Her daughters and I would like to take her to the best, either House Ear Institute or Dr. Friedman at UCSD. However, her Medi-Cal Insurance has declined to pay for an out-of-network doctor. They want to send her to Dr. Bader in Glendale California. I am new with understanding Medi-Cal. How do I appeal the decision of the Insurance? How can I get her covered for the best doctors? Her daugthers are going through the appeal process but it does not look promising. We are trying to get a letter from her Primary Care physician attesting for her need for a great doctor to do AN craniotomy surgery. Should I seek an attorney of some sort? Can you tell me how to succesfully appeal her denial of an out-of-network doctor?
