Specialists, Surgeons Hard to Find for Some Medi-Cal Beneficiaries With Benefits Through Fee-for-Service Plans
Medi-Cal beneficiaries under fee-for-service systems in some Central Valley counties face difficulties locating specialists and surgeons who will treat them, the Modesto Bee reports. Some specialists and surgeons do not treat Medi-Cal beneficiaries because reimbursements for some treatments do not cover the costs of care, according to the Bee.
In Stanislaus County, for example, Blue Cross of California offers a Medi-Cal HMO, but critics say most specialists in the county do not accept the health plan. In Merced County, more than 70,000 Medi-Cal beneficiaries receive benefits through a fee-for-service system and "are largely on their own in finding doctors," the Bee reports.
Silvia Diego, chief medical officer for Golden Valley Health Centers, said Golden Valley clinics in Merced and Stanislaus counties often have to send low-income patients to Fresno, Stockton or the Bay Area for treatment. Patients referred to university hospitals might have to wait two to six months for treatment, depending on their condition, Diego said. In addition, out-of-county surgeons sometimes are reluctant to operate on patients who do not live nearby because they of the possibility of complications, she said.
Ken August, a spokesperson for the Department of Health Services, recognized the challenges beneficiaries in counties with fee-for-service Medi-Cal plans encounter, saying, "That is why we have been expanding Medi-Cal managed care in California." August said that Medi-Cal managed care plans are obligated to find specialists for their members (Carlson, Modesto Bee, 9/19).