Josephine Guardo (fictitious name) is a middle-aged Medi-Cal consumer who moved from Los Angeles (LA) County to Orange County (OC). She had received therapy services by a provider through Health-Up Insurance (fictitious name) in Los Angeles County while her Medi-Cal was in Medi-Cal Fee-for-Service (FFS).
Followed the procedures
Ms. Guardo had done everything right—she reported her move to LA County prior to her move to OC and was notified that she could continue to utilize all her Medi-Cal covered services in LA County until her case got transferred to OC. This is why Ms. Guardo was shocked to receive a bill charging her for services (therapy sessions) for $620.88 from the therapy center. Needing assistance with sorting out the situation, she contacted Community Legal Aid SoCal, and we, the Health Unit, took her case.
Escalating the matter to resolution
Despite sending an illegal balance billing letter with legal authorities and emails from us, Ms. Guardo’s therapy provider was adamant that they can bill her since she was no longer with Health-Up Insurance Medi-Cal and in FFS. We escalated the matter with the Department of Health Care Services and requested to reach out and train/educate the therapy provider on illegal balance billing protection for Medi-Cal members. As a result, the therapy provider confirmed they will not balance bill Ms. Guardo, who was very relieved to hear the outcome.
