Corazon receives life-saving surgery and keeps critical public benefits

For nearly eight years, 72-year-old Corazon Lugod has visited the AmeriCare Adult Day Health Care Center for needed therapy and exercise, and to socialize. Recently, however, she came close to losing all of that when a problem arose with her managed care plan. That’s when Asako Okuma, a social worker at the health care center, reached out to the National Senior Citizens Law Center (NSCLC) on Corazon’s behalf.

Like many Californians, Corazon was recently required to join a Medicaid managed care plan to keep her Community-Based Adult Services (CBAS) benefits, which pay for her adult day care. Medicare beneficiaries that enroll in a Medicaid plan are supposed to be able to continue seeing their Medicare doctors, but this wasn’t the case for Corazon.

Corazon needed heart surgery but when her cardiologist, a Medicare provider, learned that she enrolled in a Medicaid managed care plan, he canceled the surgery, fearing that he would not be paid. This caused Corazon a great deal of anxiety - the last thing she needed given her heart condition. Corazon was concerned she would have a long wait before she could get her surgery, or worst, that she would not get it at all if she could not find a new cardiologist.

Okuma called the doctor's office and managed care plan to see if the situation could be resolved. Okuma was told nothing could be done and that Corazon needed to disenroll from managed care if she wanted the surgery. Disenrolling from managed care, however, would mean losing her CBAS benefits.

NSCLC was able to take the problem straight to senior leadership at the health plan. The plan was able to convince the cardiologist to agree to accept payment from the plan and the surgery went ahead as scheduled. “It was life and death for Corazon,” Okuma said. “NSCLC is a great resource.” Donate now to help people like Corazon obtain critical legal aid.

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