November 23, 2020
With Open Enrollment for health insurance upon us, it’s a great time to introduce one of the dedicated members of Venice Family Clinic’s Health Insurance Enrollment department. Sandra Martinez is part of a team of nine that helps anyone who inquires, whether that’s a new or existing patient, get the health care coverage that works best for them.
Sandra started her career with Venice Family Clinic as a temporary employee in 2012 and was hired by the Clinic the following year. She recently took on the role of health insurance specialist lead, overseeing and troubleshooting complex cases, assisting staff with urgent coverage needs and resolving difficult cases, and handling special projects.
VFC: What kinds of things does our Health Insurance Enrollment team help our patients with?
SM: We advocate for every person at Venice Family Clinic. Even if someone calls us who isn’t a patient, we will still help that person.
For patients who don’t have insurance, we’ll help them apply for Medi-Cal. If they had Medi-Cal but are no longer active, we’ll contact the Department of Social Services to find out why their coverage was terminated. We’ll help families that don’t qualify for Medi-Cal sign up for Covered California. Open Enrollment started November 1, but not all families can afford to pay the Covered California premiums, especially since COVID started and many have lost jobs or hours at work. So they now qualify for Medi-Cal, and we’ll help them with that transition. If someone is struggling to pay their rent, we’ll help people apply for CalFresh, which is California’s name for the SNAP program (also known as food stamps), to help them save money. For our Common Ground patients, we’ll assist them with applying for the AIDS Drug Assistance Program, which will cover the medications they need. We make sure everyone is covered.
VFC: How does the process work?
SM: Our Health Insurance Enrollment team screens everyone. If a patient doesn’t have insurance, we’ll help them apply. If they already have insurance, we’ll call the insurance plan to make sure Venice Family Clinic is listed as their provider organization.
Once we process the application, we follow up about four months later to verify that the patient has gotten their benefits and are using medical services. We also follow up with patients once a year to help them renew their eligibility.
We used to do this in person, but since COVID started, we can do everything by phone and email. For anyone who doesn’t use email, we still offer in-person pick-up and drop-off for the paperwork.
VFC: Once they’re signed up, does the Health Insurance Enrollment team help connect our patients to the care they need?
SM: Yes. For example, we help connect our prenatal patients to our Health Education department. Especially for first-time moms, they get excited to learn that their partners can also attend these educational sessions. I always push them to bring their partners because they need to know what’s happening with their baby, too. Our patients with diabetes are also connected to Health Education.
Some patients think we’re social workers and will start talking about their personal lives with us. We’ll connect them to our Behavioral Health department, or the domestic violence counselor specifically. Our team is pretty good when it comes to noticing when patients are trying to say something else.
VFC: How do you approach your work?
SM: When patients ask me what’s the best plan for them, I ask them about their health and the medications they take. Then I’ll reach out to our Pharmacy department to ask them which plans cover those medications. We will do our research to see what’s best for each patient. It’s about teamwork.
VFC: Do you have an example?
SM: I once did an application for one of our patients experiencing homelessness. Dr. Coley King had been giving this patient medication that was expensive, and he needed insurance coverage. Katie [from our partner organization The People Concern] came to see me at our Rose Avenue clinic with this patient’s documents, and I expedited the application. We helped him get HMO Medi-Cal in less than two weeks. We stayed on it until he got it.
VFC: Have there been any interactions with patients or experiences that stick out to you?
SM: There was an older woman who was crying because she didn’t know how to apply for benefits, she didn’t have children to help her. I thought, this woman could be my mom, and I wouldn’t want my mom to go through an experience like that. I realized that I’m here to help, to solve problems, to advocate. So every time I talk to someone, I treat that person like my mom.
VFC: What’s your favorite part of your job?
SM: When I’m able to help families who have been struggling on their own, trying to fix their benefits and they haven’t had any luck. When I assist them, their stress is less because I took care of it and the advocacy I did for them was successful. This makes me satisfied.