I'm sure not getting this Medicaid thing yet

Discussion in 'General Parenting' started by Fran, Dec 9, 2005.

  1. Fran

    Fran Former Site Owner

    I just starting reading through the info on Medicaid. We are going to keep it as a secondary insurance.
    None of the doctors are close by and none are any that we use.
    Do we have to drop the psychiatrist we used for 10 yrs?
    I have a call in to the office for help clarifying all this stuff.

    Does anyone have any experience with Medicaid as a secondary and how to go about doing it?

    Do we submit all the receipts of expenses that weren't covered by medical insurance back to the start date?
  2. OTE

    OTE Active Member

    Sorry... not aware that you can get it as secondary other than if it's through SSI or adopting through the state a spec needs child... but it sure varies by state.

    Yes, you submit receipts for bills back to retro date.

    I haven't seen a medicaid plan that lets you go "out of network" so to speak unless you're paying cash... and if you pay for a child it counts as income to the child. Yes, it's often the worst docs who take the minimal amt that medicaid pays. That's why most of us end up going through a hospital clinic. But ask the provider and/or the billing person for that doctor. if they're affiliated with a clinic that takes medicaid they may be able to change him to a clinic rather than private patient.
  3. Fran

    Fran Former Site Owner

    OTE, since difficult child is diagnosed with all the alphabets, he is eligible to stay on husband's insurance after he is finished school in May.
    Medicaid is the secondary with husband's insurance as a primary.
    I am skeptical so far but I have been referred to the website to do some reading. It will help us pick one of the 3 options based on which medications he is on.

    I can't believe how UN simple the information is to digest.
  4. OTE

    OTE Active Member

    Every state is different. Most now have some kind of HMO type option (s). But in the two states I've been in there's nothing re medications on Medicaid. You can go to any pharm you want... and most all take medicaid. And the co-pay is the same no matter where you buy it. Just went up here. Was $1 generic and $3 name brand. Now $3 for all. This is for a one mo supply of any prescription medication. You're on your own for OTC. Only trick is that you can only go to one pharm per mo.... can't pick up medications from two pharmas in the same mo.

    This is through SSI or through reg medicaid for low income/ assets? Where I am now there's a difference. The SSI ones have no HMO. But for me and my middle one there's an HMO. Not complaining because I just signed us up with the local major hospital for everything except scripts. And because it's a public hospital if I don't have the dr visit co-pays they don't bother collecting them. If I need lab or x-rays it's right there.

    In prior state it was very, very difficult to find doctors who took medicaid and no local hospital. I recall needing a lab one time and they wouldn't use any local, major co labs. Had to go to one miles and miles away which would only take us during school hours on certain days.... whole nightmare. So it really depends by state.
  5. bigblueagain

    bigblueagain New Member

    sorry just now getting to check the board. Our difficult child had medicaid as secondary since she went to the group home. However most of the psychiatrists she saw just filed with medicaid primary as it was evidently too much trouble for them to file both. Not my problem, she doesn't live with me. However whenever one of them did file with our primary, medicaid paid whatever was the copay amount for the primary. Very easy in this state, as most all the psychiatrists here have to be BC providers as it is about the ONLY major player in the state as well as most take medicaid because the BC here pays so bad they will take it just to help them out.It is nice to have it as a secondary no matter what. difficult child is now on it primary as my husband is unemployed now so she has better coverage than us!!!! BLUE