Medi-Cal Verses Commercial Insurance

Medi-Cal verses Commercial Insurance

Most people will agree that the healthcare industry is a political whirlpool; sad but the reality is that its largely based on money. It takes you back to the clichй about “the haves” and “the have-nots.” I work for Alameda Alliance for Health a not for profit Medi-cal insurance provider, which supplies both Medi-cal insurance as well as commercial insurance. Whether you have healthcare insurance supplied through your place of business or if it is given to you through

the state, there are differences between the two. The real question is: Are you receiving the same type of care whether you are covered through your local state insurance or commercialized health plans?

Medi-cal is the government supplied health care insurance for people in California. The Medi-Cal program is used to provide essential medical care and services to preserve health, alleviate sickness, and mitigate handicapping conditions for individuals or families on public assistance, or whose income is not sufficient to meet their individual needs. (Medi-Cal, 2007) The Medi-cal population is made up mostly of the low income, and uninsured people of the state. This type of population is usually stereotyped as the people who take the healthcare that they are offered for granted. They are assumed to be late for appointments or careless with their health opportunities. It is usually offered to people who cannot afford healthcare insurance, single mothers and children, as well as people who have currently been seen in medical facilities that do not have medical insurance at the time of service.

Commercial insurance is considered the type of insurance people would receive through their place of business. Alameda Alliance offers what they consider their commercial healthcare insurance to people who work for In-Home Support Service (IHSS). These populations of people are considered privileged out of the two, only because they have jobs and are considered labors. Therefore, should receive the best the healthcare industry can offer. This company employs people who provide in home care to their relatives or family friends as their primary job.

If you carry the Medi-cal supplied insurance you have the opportunity to receive a variety of services, including routine check-ups, well-baby visits, emergency services, home health and hospice. While having Medi-cal there are certain services that are not included in the coverage, which can be considered political carve-outs. For example, if a patient had chronic back pains and wanted to be treated by an acupuncturist, that type of services is considered elective and is therefore carved-out of the benefit structure. There are several carved-out benefits that are considered elective by Medi-Cal standards which include chiropractors, plastic surgery and acupuncture, and biofeedback just to name a couple. If these services are elective than Medi-cal will not pay them but would not give any discount towards the service if the patient decided to pay out of pocket.

On the other hand, if you have a commercial healthcare coverage you have the benefit of having almost all services available to you. There are only minimal services that would be consider a carve-out and those services