Getting Medical Treatment

What is a medical consenter?

A medical consenter is a person who is allowed to make decisions about the medical care you may need. This person may be a foster parent, a case worker/manager, a relative, or your parent. In most cases. a doctor may not treat you unless your medical consenter is there and has approved the treatment. This person will be able to make medical choices for you, unless you need extraordinary (more serious) medical care and treatment. If this happens, or if your consenter is not willing or able to provide consent, a court order is needed. An example of treatment that may need a court order is surgery or any treatment where sedation is needed.

Is there ever a time I don’t need a medical consenter?

In an emergency when you are in danger, doctors do not need your medical consenter to treat you in a hospital, doctor’s office, or clinic.

What is an emergency?

An emergency is when you are really hurt or sick and need medical attention right away.[5] These are some examples of an emergency:

  • Broken bones
  • Gun or knife wounds
  • You are pregnant and in labor (the baby is coming) or you are pregnant and bleeding
  • Severe chest pain or heart attack
  • Drug overdose
  • Poisoning
  • Bad burns
  • Shock (you may sweat, feel thirsty or dizzy, or have pale skin)
  • Convulsions or seizures
  • Trouble breathing
  • Suddenly unable to see, move, or speak

(This list does not include every emergency. If you have other problems that you think could be an emergency, call 911 or go to the emergency room. If it is an emergency, then the doctor can help you without your medical consenter’s permission.)

 What if I feel too sick to wait for a doctor’s appointment, but the medical issue is not an emergency?

Your caregiver may call your Primary Care Provider (the doctor you normally see) to see if you can receive help over the phone.  If you cannot wait to see your Primary Care Provider (or your Primary Care Provider’s office has closed), then your caregiver may call a 24 hour health phone number and talk to a registered nurse over the phone. If you have Sunshine Health that number is at 1-866-796-0530. If you have another insurance plan check the website or handbook for that number. You can also go to an urgent care center, which can help with some immediate health issues but not all. To find your nearest urgent care center, your caregiver may call 1-877-711-3662, visit the Florida Statewide Medicaid Managed Care website, or visit your plan’s provider directory. If the medical concern becomes an emergency, you can always go to the emergency room or call 911.

 How often should I go to the doctor?

You should visit your primary care physician at least once a year for a check-up, and if you are feeling sick then you should visit sooner.

Do I need to bring my insurance card every time I go to the Doctor?

Some doctors want you to bring it every time you see them. Some doctors are ok with a photo of the insurance card that you can take on your phone. Some doctors will see you even if you only know your insurance number. To be safe, keep your insurance card with you if you can. Take a picture of your insurance card and keep it on your phone or in your email in case your card is lost or damaged.   

What happens if I lose my insurance card?

Call the member services for your insurance plan to report it lost or stolen,. They should be able to send you a temporary card while they mail out a permanent one which can take some extra time. For Sunshine Health, member services may be reached at 1-866-796-0530.

Can I get my glasses replaced if they are broken or lost?

Your insurance lets you get two pairs of glasses each year. That means if you lose your glasses, they are broken, or you need a new prescription, you can get another pair. If they are broken and only one piece is broken, then they may be fixed.

A picture of an adorable blue cartoon pit bull named Scrappy.

SCRAPPY TIP: Keep your old glasses so that you have a back-up in case your new glasses are lost or broken.

Does my insurance cover dental services?

Yes. Your insurance covers medically necessary dental services. The following list of services is available to you:

  • 1 complete exam of your teeth every three years to see if you have any problems or need any new teeth 
  • 2 visits to see the dentist per year
  • 2 Assessments of your teeth per year
  • 2 screenings of your teeth per year
  • 2 cleanings of your teeth per year
  • 2 dental x-rays (pictures) per year
  • Endodontic services (such as root canals, dental implants)
  • Orthodontic services (such as braces and retainers)
  • Surgical and restorative procedures (such as crowns)

Your insurance will always cover relief of pain and infections in your teeth, fixing your teeth, keeping your teeth healthy, and medically necessary orthodontic services. This means that your insurance will pay for braces if they are medically necessary. The doctor looking at your teeth will tell you if it is medically necessary for you to get braces. Usually, it is medically necessary if you have problems talking, eating, or swallowing.

Does my insurance cover birth control?

Yes. Your insurance allows for one supply of birth control every month.

What happens if I need treatment that isn’t covered by my insurance?

Your insurance has to provide you with any care that you need, even if your insurance plan might not usually pay for the treatment. Your caregiver and/or medical consenter, and doctor will need to talk to each other and help you get coverage if it is medically necessary. If you think you have been denied services that Medicaid should be paying for, you can file a complaint HERE. If you file a complaint, the situation will be reviewed to see if you should be getting the medical services you were denied.

What if I don’t want to talk to the doctor in English?

Your insurance will give you services that interpret the English to another language. Talk to your caregiver and/or medical consenter about asking for an interpreter the next time you talk to your doctor. 

What do I do if it is hard for me and my guardian to get to my appointments?

Your insurance offers help for you to get to your appointments even when they are not an emergency. This may include bus fare, vans, taxis, etc. If your insurance is through Sunshine Health, you must get permission, and call LogistiCare’s customer service at 1-877-659-8420.

How can I get tylenol/cough medicine/allergy medicine?

Your caregiver must get you any medicines you need, but there are some options to get extra money for over-the-counter medications. Florida Medicaid plans might pay for drugs that you can buy without a prescription. For example, under Sunshine Health, your guardian can ask for an extra $25 every month for “over the counter” medical supplies which are ordered from a Sunshine Health catalogue. You can have your caregiver get over-the-counter products such as vitamins, aspirin, some birth control products, and Band-Aids by calling 1-866-577-9010 to ask for the items be mailed to you. If you think your caregiver is not giving you the medical supplies you need, you should talk to your guardian ad litem, case manager, the judge at your next court hearing, or another adult that you trust.

What are my options if I think the doctor may be wrong about what is making me sick?

Your insurance lets you get a “second opinion”, which means another doctor will see what is making you sick. If you don’t agree with your doctor, you can ask your caregiver or case manager to see another doctor. You can also bring this issue up to your Guardian ad litem or attorney if you have one, and/or the judge at your next court hearing.

What if I don’t like my doctor and I would like a different one?

Your insurance lets you change your doctor at any time if you want to. To change your doctor, you need to tell your medical consenter and guardian what the problem is with your current doctor and ask them to find you a new one who is covered by your insurance. If you know of a doctor that you want to see, tell them that too. You, or your medical consenter can get information regarding your options by calling the Medicaid Options toll-free help line at 888-367-6554.

What happens if I don’t agree with a decision that my medical consenter/caregiver has made for me?

Try telling them why you believe they are wrong and listen to why they made that decision. You may be able to agree on a decision. If you still do not agree with them, you can talk to another adult that you trust and that can help you. You can also speak to your Guardian ad litem or attorney if you have one, or the judge at the next court hearing.

What happens to my insurance when I turn 18?

If you were getting insurance from Medicaid, including Sunshine Health, when you age out of foster care, you can get Medicaid until you turn 26.

The Law

42 U.S.C. sec. 1395dd, Fla. Stat. sec. 39.407, 395.002, 409.905, 641.51, 743.064, 766.103, 984.19, Fla. Admin. Code R. 59G- 1.050, 1.058, 4.030, 4.060, 4.330, 4.340, 5.020

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