My question involves insurance law for the state of: California
My wife has Cystic Fibrosis and received a double lung transplant 4 years ago. All of her life, she has had her medical expenses paid for via Medi-Cal and GHPP. Ever since the Affordable Care Act has been put into place, she has received less and less coverage. Recently, as a result of the ACA, her medical insurance switched from "Medi-Cal" to "Anthem Blue Cross Medi-Cal." Anthem is denying her the life-preserving clinical testing and check-ups that are needed to monitor her health and medications. Before the ACA went into affect, she could virtually see any specialist she needed with no problems, and now even the simplest of health services are difficult to obtain at best.
She received her lung transplant at Stanford, where she has been going for almost all of her life (she is now 35). On September of last year, we were at Stanford waiting for her appointments with various specialists when we received a call from the insurance company stating that they would not cover Stanford any longer, saying to her "You're healthy enough and don't need it." She has tried to appeal, and even had her social worker and the high-ranking transplant doctors at Stanford attempt appeals as well, but they have all been denied.
If she can get back to regular Medi-Cal, then she can return to Stanford and get the healthcare she needs. However, the organization has denied her at every attempt.
Is there any way to remove her from Anthem Blue Cross Medi-Cal and switch back to regular Medi-Cal?
If all else fails, is it possible to sue Anthem or the govt in order to get her switched back?
Thank you in advance for your help.
My wife has Cystic Fibrosis and received a double lung transplant 4 years ago. All of her life, she has had her medical expenses paid for via Medi-Cal and GHPP. Ever since the Affordable Care Act has been put into place, she has received less and less coverage. Recently, as a result of the ACA, her medical insurance switched from "Medi-Cal" to "Anthem Blue Cross Medi-Cal." Anthem is denying her the life-preserving clinical testing and check-ups that are needed to monitor her health and medications. Before the ACA went into affect, she could virtually see any specialist she needed with no problems, and now even the simplest of health services are difficult to obtain at best.
She received her lung transplant at Stanford, where she has been going for almost all of her life (she is now 35). On September of last year, we were at Stanford waiting for her appointments with various specialists when we received a call from the insurance company stating that they would not cover Stanford any longer, saying to her "You're healthy enough and don't need it." She has tried to appeal, and even had her social worker and the high-ranking transplant doctors at Stanford attempt appeals as well, but they have all been denied.
If she can get back to regular Medi-Cal, then she can return to Stanford and get the healthcare she needs. However, the organization has denied her at every attempt.
Is there any way to remove her from Anthem Blue Cross Medi-Cal and switch back to regular Medi-Cal?
If all else fails, is it possible to sue Anthem or the govt in order to get her switched back?
Thank you in advance for your help.
Health Insurance: Wife Being Denied Healthcare by Anthem Medi-Cal
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