How does Medi-Cal coordinate with other insurance?

Medi-Cal coordinates with other insurance primarily through a process known as "coordination of benefits." This arrangement ensures that individuals who have both Medi-Cal and another type of health insurance can receive comprehensive care without facing unnecessary costs or complications. When an individual has more than one insurance policy, Medi-Cal generally acts as a secondary payer. This means that the other insurance is billed first for covered services. In a situation where an individual receives medical care, the provider will submit the claim to the primary insurance first. The primary insurance pays its share, and any remaining balance may then be sent to Medi-Cal for payment. It is important for individuals to provide their providers with information about all their insurance coverage so that claims can be processed accurately and efficiently. Medi-Cal has specific guidelines regarding what services it will cover, especially when another insurance plan is involved. Some services may be fully covered by the primary insurance, while others may require additional billing to Medi-Cal. Moreover, individuals should be aware that certain Medi-Cal benefits may not be available if a person has other insurance coverage. To navigate this process smoothly, it can be beneficial for individuals to familiarize themselves with the details of both their Medi-Cal benefits and any additional insurance plans they may hold. Comprehensive information regarding the coordination of benefits is typically available on the California Department of Health Care Services website, where individuals can find resources and guidance tailored to their specific situations.