Not Falling Through the Cracks

Diane can beat just about anyone at Scrabble. She’s had a lifelong fascination with kaleidoscopes and anything having to do with poodles. Her poodle-beagle mix, named Lucy Latte, has charmed nearly everyone in the neighborhood.

The 59-year-old Berkeley resident is also a dual eligible and is receiving Medicare and Medi-Cal because of a disabling mental health condition. For years she has struggled not only with her disability but also with accessing doctors to take care of her overall health.

She hadn’t had a psychiatrist in a long time — or an optometrist. Until recently, she hadn’t been to a dentist in four years.

“If you tell a doctor you’ve got Medi-Medi, they say goodbye, because nobody takes it anymore,” Diane says. “I understand, because they’re getting paid less to take care of these people. They have lists of doctors who will take you, but either the person isn’t there anymore or they don’t take the insurance. So it limits your choice of providers, especially in the mental health field.”

But two months ago, Diane joined a managed care plan in Alameda County that has a tailored program for dual eligibles, and, for the first time, a doctor came to her home to examine her and take her health history. She was impressed.

“He was very nice. I was a little bit leery of having this doctor come to my house who I didn’t know. But he was pretty thorough. He took my blood pressure and my family history. He was here for about 45 minutes.”

Under her new plan, Diane has access to dental care and was able to see a dentist shortly after the plan kicked in. She now has a list of psychiatrists, psychotherapists, primary care doctors, and even chiropractors who accept her insurance.
For Diane, psychiatric services are crucial. For some time she’s been looking for a therapist and a doctor to monitor her medications.

“I wasn’t able to see a therapist,” she says. “The clinic where I used to go doesn’t have therapy anymore. I tried to get back on psychiatry there, but I couldn’t. You have to wait until something really major happens.” For Diane, that would mean hospitalization.
Even with her new plan, Diane is wading through lists of providers and figuring out what medications are covered and which are not. There was some lag time receiving medications through the managed care plan, but she says she’s getting her prescriptions on time now.

Shortly after she joined her new plan, Diane got a call from a social worker who was assigned to help Diane coordinate her care. When the appointment had to be cancelled, the social worker followed up with a phone call to reschedule.

“They’re on the ball,” she says. “They don’t let you just fall through the cracks.”