AScott Insurance & Financial Services

Man, I’m happy!

A woman was referred to me for Covered California by another Medicare insurance broker. She is under 65 and had been on Medi-Cal while receiving her deceased husband’s Social Security benefits. Last December, her Medi-Cal was terminated after her annual redetermination showed her income was $201 per month over the eligibility limit.

Unfortunately, this happened while she was recovering from a broken hip and recent bunion surgery.

When I received the referral, I didn’t yet realize she had already missed the deadline to enroll in a new health plan after losing her Medi-Cal. That meant she would normally have to wait until the next Open Enrollment period to get Covered California.

Meanwhile, she was in significant pain and still needed follow-up care, along with help covering the cost of her prescriptions.

After meeting with her, I determined the best course of action was to file an appeal of the Medi-Cal redetermination decision.

I went to her home and helped her submit the appeal online. We requested an expedited hearing, and when the hearing date came, I returned to her home (at her request) to be there with her during the call. I assisted where needed as she spoke with the judge and the county representative. By the end of the hearing, I felt cautiously optimistic.

A couple of days ago, I followed up with her and I’m happy to report the appeal was approved. Her Medi-Cal benefits have been restored.

This Wednesday, I’ll be going back to her home (again, at her request) for an intake meeting with InnovAge PACE (Program of All-Inclusive Care for the Elderly), so she can continue getting the care she needs.

This was a tough case but so incredibly rewarding!