Helping Californians Get and Keep Their Healthcare!
The Health Consumer Alliance (HCA) is a statewide partnership that offers Free Over the Phone or In-Person Assistance to help California residents struggling to get or maintain health coverage and resolve problems with their plans.
Supporting California’s Aging and Disabled:
How Bay Area Legal Aid Advocates Erased a Costly MistakeA senior with disabilities in Alameda County was taken unconscious to a county hospital in 2018. When he awoke, he told the hospital doctors that he had Medi-Cal and showed them his Medi-Cal card. Ninety days later, he received a bill for more than $40,000, none of which was billed to Medi-Cal.
After that, he started receiving calls from a collection agency.
He called the hospital and told them repeatedly that he was a Medi-Cal recipient to no avail; the hospital told him he was already in collections and there was nothing they could do. He discovered the bill was affecting his credit when he tried to apply for a loan and received a credit check, at which point he contacted HCA partner, BayLegal.
BayLegal advocates quickly issued a demand letter on the client’s behalf to the bill collectors and further issued verbal demands that the collection agency complies with California’s Medi-Cal balance billing laws.
The collection agency canceled all six of his accounts, returning them to the hospital and zeroing out his balance, and reported the zero balance to the credit reporting agencies.
Closing the Gap:
Maintaining Coverage for Crucial Cancer TreatmentHCA partner, Inland County Legal Services (ICLS), supported a Riverside County resident battling advanced tongue cancer. The client experienced a sudden disruption in their health coverage after being hospitalized and placed in a medically induced coma. While in the hospital his coverage was switched to Medi-Cal after a hospital social worker helped his wife apply for Medi-Cal but erroneously misrepresented their income.
When the client was discharged from the hospital, they discovered that the team managing his cancer treatment did not accept Medi-Cal. This left the client in a dire situation, unable to access crucial, time-sensitive care they urgently relied on. After many fruitless calls to Covered California and the Medi-Cal office at the county, the client contacted ICLS for help.
ICLS advocates quickly escalated the case through Covered California advocating for restoration of his Covered California eligibility retroactively. While the client had to pay the premium for the prior month, his lifesaving cancer treatments were reinstated.
The family shared that they could not have resolved the problem without the help of ICLS advocates.Turning Crisis into Coverage:
A Life-Saving Win for a California ResidentIn August of 2020, a 68-year-old Spanish-speaking man suffered a heart attack, leading to costly hospitalizations in Imperial County and San Diego. With over $300,000 in medical bills and no health coverage, he faced financial devastation-until HCA partner, California Rural Legal Assistance advocates stepped in.
CRLA advocates helped him join his wife’s Medi-Cal case, but the county initially miscalculated his income, assigning him an unreasonably high share of cost. CRLA appealed the decision, and before the hearing, the county reversed course-agreeing with CRLA’s legal analysis and granting him full Medi-Cal coverage with no cost-sharing.
Thanks to CRLA’s advocacy, he avoided crushing medical debt and gained ongoing access to vital care and services.A Mother’s Relief: CLA SoCal Advocacy Clears $61,000 Bill for Infant’s Emergency Care
An Orange County resident sought the help of HCA partner Community Legal Aid SoCal (CLA SoCal) upon receiving an uncovered $61,000 bill for helicopter ambulance transport for her 10-week-old infant experiencing seizures.
The infant needed emergency transportation from a general trauma center to an in-network children’s hospital across town. The health plan claimed alternative transportation was available; however, ground transportation was not available due to social unrest in the community, including blocking of streets and rioting. The health plan denied the claim resulting in a bill of $61,000.00 to the consumer from the transportation company.
CLA SoCal advocates helped the consumer file a successful appeal to the California Department of Managed Health Care (“DHMC”), in which they filed a brief laying out the applicable clinical criteria and medical necessity standard, and provided evidence of the unavailability of ground transportation. The DMHC agreed and ordered the health plan to pay for the air transport as it was deemed medically necessary, and to send confirmation of payment of the expense within five days.
The consumer was extremely relieved that her infant received timely and appropriate services, and grateful to CLA SoCal’s advocates for their services.
Medical billing cases such as these regularly rank in the top three most common problem faced by consumers of the Health Consumer Alliance. Please see our Know Your Rights page, and search the word “bill” to learn more about your rights related to medical billing and call your local Health Consumer Alliance partner if you need assistance.Keeping Californians Covered Through Advocacy and Bridging Language Barriers
A non-English speaking older adult residing in San Bernardino County, who was a dual eligible beneficiary with Original Medicare and Medi-Cal Managed Care enrollment, had his Medi-Cal eligibility terminated by the county despite the COVID public health emergency stay on negative actions. As a result of the termination of Medi-Cal coverage, he was disenrolled from his Medi-Cal plan and was unable to schedule transportation or access any needed appointments for his chronic heart condition.
HCA partner, Inland Counties Legal Services (ICLS) immediately intervened to help the client.
After requesting an expedited hearing, ICLS was able to quickly negotiate a resolution with the county to retroactively establish his Medi-Cal. ICLS then continued their advocacy with the state to ensure the consumer was retroactively enrolled into his Medi-Cal managed care plan. Once enrollment was confirmed, the consumer was able to schedule medical appointments and needed transportation services.
