Healthcare Partners Medical: Limon Jack MD

Sep 2022

Optum has an issue with those of us who meet our Out Of Pocket Maximum (OOP) for any calandar year and despite the insurance company telling them in fax, email and verbal over the phone MULITPLE times REFUSES to stop ILLEGALLY (HIPPA guidelines apply here) charging me a copayment I do not owe since mid March 2022, And just for fun: Optum has no records of any communication with me or Anthem Blue Cross (my insurance provider), Anthem has all their records of their communications with me and Optume with ID numbers and date/time stamps. Anthem has filed a grievance agaisnt Optum. For those who do not understand your insurance company's role: your insurance company is the one who pays your medical group to manage your care a pretty hefty dollar amount on a monthly basis (whether or not you see a doctor, it's called Capitation) to take care of your medical needs. For this to happen that medical group must be responcible enough to remain DELAGATED. IF they are proven to fail to manage the patients they are paid to manage, then that medical group can become DEDELAGATED and your insurance comany oversees EVERYTHING which means the medical group gets less money for your care since they are not able to properly manage you. This OOP is an issue I run into EVERY YEAR since having the amazing coverage I am gratefully blessed to have. I am not the only one to have these issues. I am one of the lucky ones to have a $500 annual out of pocket maximum that takes into accout not only Optum items but all my medications and mental therapy appointments as well. Generally, if you have a Commercial HMO insurance plan, all behavorial therapy is a carve out that only the insurance plan handles. Your medical group has nothing to do with that unless you have a Senior plan. All medictions are another carveout taken care of by your health plan, not your medical group who ONLY prescribes medications and if necessary takes care of the prior authorizations for some medications that require additional approval. Who am I other than just a patient having an issue? A retired healthcare worker in HMO for 30 years. I've done contracting, credentialling, provider relations, executive assistant and in the last 10 years of work I did LOA's, MOU's and was a programmer/analyst for Decision Support, Finance and Utilization Managemement. I also trained others and developed databases and manuals for others to use when needing a simple report for their own analysis. Iv'e done more than what is listed here for mulitple departments. Additionally, I am a past employee of Health Care Partners (HCP) who is now called Optum. Anthem pays Optum. Anthem also sends monthly data sets to Optum called EOB's (explanation of benefits). Optum runs their own EOB's every month and updates their information based on Anthem's. Last week I got another bill from Optum. I have called them in May, June, and July to let them know that they have already spoken to Anthem in April and the result was an official letter from Anthem stating I met my OOP maxium for the Calandar Year 2022 as of March 16, 2022. They still have no record of it as of July and still demand that Anthem get involved, AGAIN and AGAIN. Anthem has sent the letter and spoken to them on more than 3 seperate occasions. In late August I got another bill from Optum, this time I didn't want to waste more time with Optum so I called Anthem first and explained my frustation over this. Anthem called them. Again, Athem was told they HAVE TO REQUEST FROM OPTUM (who does not have all financial data for my care) A REPORT ON MY PAID CO-PAYMENTS? Anthem has already spent quite a bit of time and money for their employees to RE-do this request every time. DESPITE Anthem having already completeing this in April and sent the OFFICIAL LETTER to OPTUM in APRIL 2022??? This process took about 2 weeks back then and everytime I have called to correct Optum. Now I ask you, what kind of a$$ backwardds B$ is this? I think a class action law suit in order at this point for causeing so much stress and tra

Jul 2022

My daughter pediatrician. Dr.Low and her staff is very professional and kind. Had an appt and always felt welcome and not rushed when we had questions. Thank you for your service Dr.Low and staff

May 2022

Dr yataco Casitlla is grossly unqualified . The office is disorganized and dank. Communication is null . Prescription s don't get attention . Generally this offic should be closed.