Medi-Cal Payments

Your April 1 editorial (“Birth Pains for Medi-Cal’s Shift to Managed Care”) erred with the assertion that health care providers get the $75 per month allotted by the state for each Medi-Cal patient in the program whether or not they actually see the patient. The actual amount that physicians, hospitals, pharmacists and other caregivers get to share is $56 because the state has allowed L.A. Care (the plan administrator) and its health plan partners to retain 25% of its $75 rate for administration and profit.

For those doctors who treat Medi-Cal patients for reduced payments of $5 to $9 each, the state has allowed the health plans to require them to submit paper claims for payment instead of using electronic billing. These doctors report that paper billing will cost them $3 and more per claim to process. What a deal!

JIM LOTT, Senior Vice Pres.

Healthcare Assn. of So. California