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Patients Struggle to Learn Health Insurance Lingo

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Language and cultural barriers add to the confusion. “It’s hard to understand even if it is Spanish,” said Marisela Sanchez, 50, a new Medi-Cal enrollee from Los Angeles who has diabetes, high blood pressure and high cholesterol. “If it’s in English, it’s worse.”

Community health centers throughout the nation are seeing some of the problems firsthand.

At Eisner Pediatric & Family Health Center in downtown Los Angeles, lead enrollment specialist Martha Vasquez said the vast majority of patients who bought private insurance selected plans with the lowest premiums, not necessarily grasping that those plans came with high deductibles.

Now they are asking why the visits that they consider preventive aren’t free and whether hospital visits are included in their plans.  They also are uncertain what specialists they can see and what medications are covered.

Jessie Yuan, a physician at the center, said patients have been confused about health insurance for a long time. The new health law “just adds another layer on top of that,” she said.

Yuan said she sees it as part of her job to give a brief orientation to new Medi-Cal patients. On a recent morning, she spoke with Oscar Gonzalez, a diabetic patient from Huntington Park, in Spanish. Gonzalez had been switched to Medi-Cal from a free county program for the uninsured.

With Medi-Cal, Yuan told her patient, over-the-counter medications like Tylenol and cough syrup aren’t free anymore.  He can get a free vision appointment but will have to pay for glasses. It will be easier to get referrals to specialists, but if he needs to change the appointment, he has to do it himself.

And instead of giving him a three-month supply of medications, Yuan explained she would write a refillable prescription that would cover several months.

Gonzalez seemed bewildered.

He didn't even know he had been automatically switched to the Medi-Cal program until Yuan told him. “I knew by the news they were making some changes,” he said. “But I don’t know all the rules.”

The side effects of confusion can be harmful, providers said. Sanchez, the new Medi-Cal recipient from Los Angeles with several chronic conditions, stopped taking two of her regular medications because the doctor didn’t write new prescriptions. Sanchez concluded she didn’t need them anymore – not realizing that she was supposed to get refills.

“The concept of refill is very difficult for our patients,” said Nicole Alton, the Eisner health center’s director of pharmacy. “She is just one of hundreds of people who come and don’t understand the system.”

It’s not just low-income patients or those new to insurance who need help navigating the system.

Rob Hoerntlein, 63, had purchased private insurance before but said he is stumped by his new Covered California plan, which took effect in April.

Sat, Jun 14 2014

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