I’ll do my best to get through this clearly but it is wild and very convoluted.. I need help on what to do here.
Are there rules for employers and QLE’s? In California, are QLE’s all the same? Is there something I can do as a workaround to get Medi-cal to accept that Kaiser cannot be accessed? If the employer will not return calls, is there any recourse?
My ex, son’s father, signed our son up for health insurance through his employer and didn’t tell me or consult with me. Ex signed son up to Kaiser, but his primary is through Dignity and we are *not* in a Kaiser service area, but Ex is and the plan is under his address.
My son had Medi-Cal but we hadn’t used it in about a year. He is currently having an urgent situation, so I took him to the Dr and that’s when we found out about the Kaiser. He was given some very expensive Rx’s but Medi-Cal is denying us saying we need to go through the primary first. We cant do that as they are too far to be accessible, (and I hate Kaiser with every fiber of my being but that’s for another time), even if made the 3-hour journey – Kaiser does not fill Rx from outside physicians, and he is already established within the other medical group and getting treatment.
His employer is stating that he doesn’t have a QLE. (child moving to a different county and having other qualifying insurance) Now they aren’t returning his calls. He needs to remove him from Kaiser and either add to Blue Cross or drop him entirely. After hours of calls, this was the only possible solution. This is a very large company so im sure they have a robust HR department.
I can’t even pick up Rx at this point and we have an appt coming for a specialist and I am terrified right now. Medi-cal won’t budge, regardless of if Kaiser says we’re not in a service area, HR won’t contact him. I now have his Benefits person’s information but don’t know what to do with it yet.
Anyway, thank you for your helpful guidance. I am very stressed and scared… and I am so desperate to resolve this.
submitted by /u/hotpocketsareravioli
[link] [comments]I’ll do my best to get through this clearly but it is wild and very convoluted.. I need help on what to do here. Are there rules for employers and QLE’s? In California, are QLE’s all the same? Is there something I can do as a workaround to get Medi-cal to accept that Kaiser cannot be accessed? If the employer will not return calls, is there any recourse? My ex, son’s father, signed our son up for health insurance through his employer and didn’t tell me or consult with me. Ex signed son up to Kaiser, but his primary is through Dignity and we are *not* in a Kaiser service area, but Ex is and the plan is under his address. My son had Medi-Cal but we hadn’t used it in about a year. He is currently having an urgent situation, so I took him to the Dr and that’s when we found out about the Kaiser. He was given some very expensive Rx’s but Medi-Cal is denying us saying we need to go through the primary first. We cant do that as they are too far to be accessible, (and I hate Kaiser with every fiber of my being but that’s for another time), even if made the 3-hour journey – Kaiser does not fill Rx from outside physicians, and he is already established within the other medical group and getting treatment. His employer is stating that he doesn’t have a QLE. (child moving to a different county and having other qualifying insurance) Now they aren’t returning his calls. He needs to remove him from Kaiser and either add to Blue Cross or drop him entirely. After hours of calls, this was the only possible solution. This is a very large company so im sure they have a robust HR department. I can’t even pick up Rx at this point and we have an appt coming for a specialist and I am terrified right now. Medi-cal won’t budge, regardless of if Kaiser says we’re not in a service area, HR won’t contact him. I now have his Benefits person’s information but don’t know what to do with it yet. Anyway, thank you for your helpful guidance. I am very stressed and scared… and I am so desperate to resolve this. submitted by /u/hotpocketsareravioli [link] [comments]Read Morer/HealthInsurance