Straight medicaid... Billing Q..

lvisser

So... we have decent primary insurance that pays everything (all aba therapy) after the first $2,500.  My son also qualified for Medicaid, but because he has insurance its not thru a group plan, its just straight medicaid. 
So... we get a bill from his therapist for that 2500.00.  The way I understand medicaid, they will cover that, if the therapist bills them secondary.
When I spoke to his therapist about the medicaid she said that she is so busy, but will try and get a hold of them next week to get set up to start accepting medicaid.
I went ahead and called Medicaid too and they basically said that it was a easy phone call for her to make and it wouldn't be a huge deal.
I talked to her billing lady who basically laughed and said "yeah, easy call... ok"... i pushed and they are going to call and see what they can find out...

Do you know anything about Medicaid?  is there anything else I can do?

macchiatto

Interesting. All the therapists we've worked with have accepted Medicaid. (In my state at least, some Medicaid plans are worse than others. There's one--Molina--that many doctors and the children's hospital no longer accept.) Our kids also have primary insurance through DH's work and then Medicaid as secondary. Medicaid covers everything our insurance doesn't for therapies, or at least, we never get a bill. We just deal with passing on the checks and EOB's from our primary insurances since our therapists are all out of network.

Happy2bNappy

I have never had any issues with straight medicaid. The fact that we have a diagnosis for special needs, DS has a plan that is only for special needs children. We get authorization for therapy, office visits, medical equipment in no time. The only time I have gotten a bill was soon after DS was born. My health insurance covered DS for his first thirty days. After the 30 days were up, the doctors, hospital etc. Billed me because of course his insurance through me had expired. All I had to do was call the billing companies and give them the medicaid information I never heard from them again.

lvisser

-auntie- said:

A lot of therapists refuse to take Medicaid where I am. Hell, Neither DS's psychologist or dev pedi take any insurance and his psychiatrist takes only a handful of Blue Cross PPOs.

We were told Medicaid would cover what our primary didn't. It didn't work as the social worker at the hospital told us. It literally brought nothing to the party except it would have picked up a $10 co-pay at the PCPs office and co-pays on meds. IN my part of the state you get turfed to an unpopular HMO, in more rural areas, you get a more traditional fee for service plan. Of course, in the rural parts of the state you can't find clinicians with the expertise you need.

When I called the Medicaid office the social worker I spoke to shared that their reimbursement rates were so low that there was no way DS's psych would accept it. Turns out she grew up with his DDs and knew him well.

crap... yeah, this is what happened... Just got the call...

Oh well... They have no problem with me being on a payment plan, so i guess thats good... and what sucks is that i can't just send them my receipts to be reimbursed...