Medicaid in Washington navigation by proxy

April 16, 2017 11:43 AM

A close friend of mine needs help navigating Washington Apple Care and neither of us really even know where to start.

I set up E's healthcare, since he has serious anxiety and depression and thus needed help even getting the motivation to access his healthcare options, let alone go through the entire process. It has come out that some of why he asked for this help is because he has a painful lump on his testicle, has experienced pain from this for nearly a year, and needs help figuring out what his next steps are now that he has access to insurance.

Since I entered all the information on the healthcare exchange in January and he will give me all the other necessary info, presumably I can set up the appointments and things? But I don't even know how to begin. The understanding I have from the documentation is that the first step is getting a General Practitioner appointment, and then the GP will refer him to a urologist or whoever. Is this right? I also have a little bit of phone anxiety, so I like to have all my ducks in a row before I start calling and asking questions...

I'm not sure if this qualifies as an emergency (I consider it one kinda), and I'm having trouble determining whether any given practitioner takes the type of medicaid that E has. Like, should we jut hit up the ER and let them figure it out? That seems like the worst option, since having a "normal" doctor would probably be good in the long run anyhow but this is a more pressing concern than things like cholesterol levels and occasional headaches.

Is there a phone number where I can speak to a kind person who will help me be a non-related, non-official healthcare navigator of Medicaid? Is this an easier process than it looks to be? I am also pretty new to this whole having-insurance business, and tend to just go to my ob/gyn for any health issues, which is obviously not an option for the testicled.

posted by zinful to Health & Fitness (5 answers total)

Best answer: They should have sent a packet with all the provider information--who his GP is, etc. It should have the medicaid card (blue plastic) and a card for the provider (example: coordinated care) that has important phone numbers, primary care info, etc. You'd make an appointment with the assigned GP, and they will make a referral to a urologist after assessing the situation. They make sure the referral is to someone who takes his insurance.

If you are in Seattle and feel like he needs to see someone immediately (appointments can take a few days/up to a week), try the walk-in urgent care clinic at Swedish Cherry Hill (it's to the left of the emergency room entrance at the old Providence building). http://www.swedish.org/locations/country-doctor-community-health-center They'll check you out and send you to the e-room if necessary.
posted by lovecrafty at 12:01 PM on April 16, 2017 [1 favorite]

In my experience with Applehealth (in the form of the children's health insurance plan), they will assign him a provider and he will get that information when he gets his health insurance card. If he already has a card, look on it and see if a provider is listed.
posted by KathrynT at 12:24 PM on April 16, 2017

If his application for Medicaid was accepted,he should have been mailed a form to choose a PCP, and then he should have been mailed an insurance card. Does he have those?

In PA, where I am, applying for Medicaid through healthcare.gov doesn't always work. There is a separate online application for applying for PA Medicaid that is faster and more effective. See if you can find that or Washington. Or you could go to the local Medicaid office and fill out an application there. Once filled out, if WAshington is similar to PA,it doesn't take too long to get a decision- about 2 weeks.
posted by bearette at 1:30 PM on April 16, 2017

Best answer: I am on AppleHealth.

if he hasn't selected a insurance carrier, one will be selected for him, as well as a GP. He'll be sent a ProviderOne card, as well as a packet from the health insurance carrier that either he or WA State selected for him. He will also be able to change insurance carriers, if this is something that's desired further down the line.

Once he has that insurance card, the GP name and contact info will be listed on it. All appointments and referrals will then have to go through that GP. So, if he sees the GP, and the GP needs to refer him to a specialist? The GP has to submit that referral to the specialist, and AppleHealth needs to process and approve it - he can't just turn around and make an appointment with the specialist without that. When he has that info, however, he can then make appointments.

Here is the contact info for AppleHealth; I've talked to them before, and I found them to be friendly and unintimidating.

Apple Health Medical Customer Service Center:

Phone: [phone]
Email: [e-mail]
Online: https://fortress.wa.gov/hca/p1contactus
Business hours: Monday - Friday 7 a.m. to 5 p.m. Pacific Time (PT) (except state holidays)

They should be able to tell you who the GP is, if he doesn't have his card yet.
posted by spinifex23 at 1:38 PM on April 16, 2017 [3 favorites]

Best answer: I also have Apple Health.

I needed to go to the doctor before I was assigned a primary care doctor and called the local urgent care to make sure they took Medicaid patients and went there same day without any issues or out of pocket expenses. So that might also be an option of he feels like he needs to be seen by a doctor asap.

The people at the number spinifex listed above are really really nice and helpful.
posted by ilovewinter at 6:37 PM on April 16, 2017 [2 favorites]