Re: Medicaid questions

January 5, 2008

Hi !!

I know how " horrid " it is to try & get medicaid on a child. I went through

the experience 12 yrs. ago with Blake. We had to first go through SSI. He was

denied financially BUT approved Medically. So we had to go through TEFRA to get

medicaid.

Since they " mistakenly " mistook Blake to be an adult & beleived he could

function is socoeity with ALL of his issues, the denied him. 8 Months later we

were in front of a judge to proove Blake was a 4 yr. ols with many issues and

needed all sorts of therapy to get by. This was successful. We he was finally

approved, it ent back to his 2 surgeries when he was 3.

SInce it had been almost a yr. from applying & aover a yr. since the

surgeries, Medicaid wanted to " turn down " the claim. Since it was court ordered

to go retro to the beginning of 1995, they HAD to cover the charges.

Whatever bills that you have incurred since Aug.07 Medicaid HAS to paid.

With Blake we have both insurance and medicaid.....so, insurance is

first.Medicaid is secondary. We see NO bills from anything that he has done

medically & dentally(they do not cover ortodontics....braces). The only places

we might see a bill comein from is if that Dr. does NOT apply for secondary

insurance. With Blake, since he is high risk for any thing done & his out of

pocket is usally paid by Feb. 1st. They will bill medicaid & get inurance to pay

medicaid back!!!!

If your Dr. say your co-pay is 902.00 just give the medicaid card, & tell them

this is their insurance. They should go back to Aug. 07.

If you paid off any medical bills from 8/07 til approval, call the bills

office at the facility you were at & tell them that medicaid will cover those

bills & get your money back......that IS what we did. We had only one office

not pay us back, but we took it to court & got our money & then some because the

person over their billing dept. was fired after we told the Dr. about what

happened & she got on the ball!!!!

Good Luck with the IVIG

mom to Blake 15....soon to be 16 (going on 60...my little ole man!!!

http://www3.caringbridge.org/sc/blakester

The Greaatest Adventure of MY lifetime!!!!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

susan sorensen <sorensens004@...> wrote:

Hi,

I just received a letter stating that my kids have qualified for Medicaid and it

would be retroactive to 8/07. I have a couple questions I hope somebody can

answer.

My insurance has determined my copay for my daughter's IVIG is $902. Can I

submit that portion to Medicaid? If so, do I just forward copies of the bill

from the provider from now on? What about bills already paid since August?

Should I contact the hospital where she receives her IVIG to let them know of

Medicaid coverage and let them bill Medicaid?

It was a 7 month ordeal to get the insurance to agree to cover IVIG. Will

Medicaid be just as tough (or worse) to convince? Should I continue to pay the

copay and then hope Medicaid reimburses me?

I'm sorry if this sounds silly, but I have no idea how this works. The letter

doesn't tell me much of anything except they qualify and cards wil be issued

later.

Thanks for any help!

January 5, 2008

First thing is do not pay for another dime of copays. Medicaid will NOT

reimburse you for the money already spent out. I owuld go ahead and let the

hospital know that youi have medicaid as secondary and then let them bill the

insurance. I don't believe that medicaid will be as hard to get to cover the

IVIG because we did it for a year and didn't pay a dime of it and didn't have to

fight the insurance to get it covered.

Cassie

Future Director of the Charismatic Carolers

www.marykay.com/cassieredinger

January 5, 2008

---We have private ins thru my DH's work, and then Medicaid as

secondary. Ive never paid the bill and waited for reimbursement...I

just give my card to the office to copy, and they bill private ins

first, and Medicaid for what would have been my copay. Since I have

three kids on IVIG, this is very much appreciated around here:)

I have not ever had a problem with Medicaid paying their part.......so

far, they seem happy to NOT have to pay the whole thing!

valarie

In , " susan sorensen " <sorensens004@...> wrote:

>

> Hi,

>

> I just received a letter stating that my kids have qualified for

Medicaid and it would be retroactive to 8/07. I have a couple

questions I hope somebody can answer.

>

> My insurance has determined my copay for my daughter's IVIG is $902.

Can I submit that portion to Medicaid? If so, do I just forward

copies of the bill from the provider from now on? What about bills

already paid since August? Should I contact the hospital where she

receives her IVIG to let them know of Medicaid coverage and let them

bill Medicaid?

>

> It was a 7 month ordeal to get the insurance to agree to cover IVIG.

Will Medicaid be just as tough (or worse) to convince? Should I

continue to pay the copay and then hope Medicaid reimburses me?

>

> I'm sorry if this sounds silly, but I have no idea how this works.

The letter doesn't tell me much of anything except they qualify and

cards wil be issued later.

>

> Thanks for any help!

>

January 5, 2008

YAY!!!!!!!!!!

I would tell the hospital and have them bill all your past copays to medicaid.

They should then reimburse you for what you have already paid. Then, in the

future, you should not have to pay anything.

My son also has private insurance as primary and Medicaid as secondary and we

never pay a cent unless we choose to go to a doctor that is not a Medicaid

provider.

With IVIG, the primary insurance needed all kinds of info to preapprove IVIG

but with Medicaid, it was no problem.

Betsy - mom to Henry - 9 3/4 yr old - CVID - starting IVIG on 1/11/08

susan sorensen <sorensens004@...> wrote:

Hi,

I just received a letter stating that my kids have qualified for Medicaid and it

would be retroactive to 8/07. I have a couple questions I hope somebody can

answer.

My insurance has determined my copay for my daughter's IVIG is $902. Can I

submit that portion to Medicaid? If so, do I just forward copies of the bill

from the provider from now on? What about bills already paid since August?

Should I contact the hospital where she receives her IVIG to let them know of

Medicaid coverage and let them bill Medicaid?

It was a 7 month ordeal to get the insurance to agree to cover IVIG. Will

Medicaid be just as tough (or worse) to convince? Should I continue to pay the

copay and then hope Medicaid reimburses me?

I'm sorry if this sounds silly, but I have no idea how this works. The letter

doesn't tell me much of anything except they qualify and cards wil be issued

later.

Thanks for any help!

January 5, 2008

, You should have a caseworker You can call the DHS office and find out who

it is. Also just let everyone know that gives you services about you new

insurance and that it is retro to August. they will rebill and you should not

have to do anything. Your bills would probably just make things more

complicated. Generally, your insurance is Primary and DHS picks up the

difference when you have both. I do not know what state you are in but this is

generally how it works but your caseworker should be able to help you more

specifically.

BARBIE

Medicaid questions

Hi,

I just received a letter stating that my kids have qualified for Medicaid and it

would be retroactive to 8/07. I have a couple questions I hope somebody can

answer.

My insurance has determined my copay for my daughter's IVIG is $902. Can I

submit that portion to Medicaid? If so, do I just forward copies of the bill

from the provider from now on? What about bills already paid since August?

Should I contact the hospital where she receives her IVIG to let them know of

Medicaid coverage and let them bill Medicaid?

It was a 7 month ordeal to get the insurance to agree to cover IVIG. Will

Medicaid be just as tough (or worse) to convince? Should I continue to pay the

copay and then hope Medicaid reimburses me?

I'm sorry if this sounds silly, but I have no idea how this works. The letter

doesn't tell me much of anything except they qualify and cards wil be issued

later.

Thanks for any help!

January 5, 2008

Hi , my son just got SSI and the judge wrote on his approval that it was

suppose to be retro to his birth. That would be a nightmare for everyone if it

included his medical bills. All I would like is payment to make up for some I

have had to put out. Any way my question is that when I talked to SSI they told

me that it would only go to the date we applied. It sounds like you went to

court for his MEDICAID but it he also on Social Security?

BARBIE

Re: Medicaid questions

Hi !!

I know how " horrid " it is to try & get medicaid on a child. I went through the

experience 12 yrs. ago with Blake. We had to first go through SSI. He was denied

financially BUT approved Medically. So we had to go through TEFRA to get

medicaid.

Since they " mistakenly " mistook Blake to be an adult & beleived he could

function is socoeity with ALL of his issues, the denied him. 8 Months later we

were in front of a judge to proove Blake was a 4 yr. ols with many issues and

needed all sorts of therapy to get by. This was successful. We he was finally

approved, it ent back to his 2 surgeries when he was 3.

SInce it had been almost a yr. from applying & aover a yr. since the surgeries,

Medicaid wanted to " turn down " the claim. Since it was court ordered to go retro

to the beginning of 1995, they HAD to cover the charges.

Whatever bills that you have incurred since Aug.07 Medicaid HAS to paid.

With Blake we have both insurance and medicaid.... .so, insurance is

first.Medicaid is secondary. We see NO bills from anything that he has done

medically & dentally(they do not cover ortodontics. ...braces) . The only places

we might see a bill comein from is if that Dr. does NOT apply for secondary

insurance. With Blake, since he is high risk for any thing done & his out of

pocket is usally paid by Feb. 1st. They will bill medicaid & get inurance to pay

medicaid back!!!!

If your Dr. say your co-pay is 902.00 just give the medicaid card, & tell them

this is their insurance. They should go back to Aug. 07.

If you paid off any medical bills from 8/07 til approval, call the bills office

at the facility you were at & tell them that medicaid will cover those bills &

get your money back......that IS what we did. We had only one office not pay us

back, but we took it to court & got our money & then some because the person

over their billing dept. was fired after we told the Dr. about what happened &

she got on the ball!!!!

Good Luck with the IVIG

mom to Blake 15....soon to be 16 (going on 60...my little ole man!!!

http://www3. caringbridge. org/sc/blakester

The Greaatest Adventure of MY lifetime!!!!

~~~~~~~~~~~~ ~~~~~~~~~ ~~~~~~~~~ ~~~~~~~~~ ~~~~~~~~~ ~~~~~~~~~ ~~~~~~~~~ ~~

susan sorensen <sorensens004@ hawaii.rr. com> wrote:

Hi,

I just received a letter stating that my kids have qualified for Medicaid and it

would be retroactive to 8/07. I have a couple questions I hope somebody can

answer.

My insurance has determined my copay for my daughter's IVIG is $902. Can I

submit that portion to Medicaid? If so, do I just forward copies of the bill

from the provider from now on? What about bills already paid since August?

Should I contact the hospital where she receives her IVIG to let them know of

Medicaid coverage and let them bill Medicaid?

It was a 7 month ordeal to get the insurance to agree to cover IVIG. Will

Medicaid be just as tough (or worse) to convince? Should I continue to pay the

copay and then hope Medicaid reimburses me?

I'm sorry if this sounds silly, but I have no idea how this works. The letter

doesn't tell me much of anything except they qualify and cards wil be issued

later.

Thanks for any help!

January 6, 2008

Thank you to everyone who responded! Looks like I'll be on the phone tomorrow

to quite a few people. One more question...Does Medicaid cover prescriptions?

If so, do I submit receipts to Medicaid? I do not have prescription coverage on

our health insurance policy and although we do use Costco mostly, some of the

kid's Rx's are compounded out of state and need to be sent overnight on ice

($$$).

Thanks again,

Medicaid questions

Hi,

I just received a letter stating that my kids have qualified for Medicaid and

it would be retroactive to 8/07. I have a couple questions I hope somebody can

answer.

My insurance has determined my copay for my daughter's IVIG is $902. Can I

submit that portion to Medicaid? If so, do I just forward copies of the bill

from the provider from now on? What about bills already paid since August?

Should I contact the hospital where she receives her IVIG to let them know of

Medicaid coverage and let them bill Medicaid?

It was a 7 month ordeal to get the insurance to agree to cover IVIG. Will

Medicaid be just as tough (or worse) to convince? Should I continue to pay the

copay and then hope Medicaid reimburses me?

I'm sorry if this sounds silly, but I have no idea how this works. The letter

doesn't tell me much of anything except they qualify and cards wil be issued

later.

Thanks for any help!

January 6, 2008

Medicaid can be difficult with some meds, we had to battle Diflucan in November.

With the dr's repeated appeals, it went through, but it is a headache.

Everything is billed straight to them and your primary insurance covers first.

Don't know about IVIG but we are headed down that road after Mollie's next appt

on the 15th I believe. Call your caseworker and become best friends with the

person who files in your physicians office. They are your best helpers.

Rita Wow!! Have you checked out the new books?? Introduce educational

excellence with Usborne Books to your community. Host a show and earn free

books! Great time to order gifts too.http://www.ubah.com/J0511/

@...: sorensens004@...: Sun, 6 Jan 2008

06:47:02 -1000Subject: Re: Medicaid questions

Thank you to everyone who responded! Looks like I'll be on the phone tomorrow to

quite a few people. One more question...Does Medicaid cover prescriptions? If

so, do I submit receipts to Medicaid? I do not have prescription coverage on our

health insurance policy and although we do use Costco mostly, some of the kid's

Rx's are compounded out of state and need to be sent overnight on ice

($$$).Thanks again, Medicaid questionsHi,I just received a letter

stating that my kids have qualified for Medicaid and it would be retroactive to

8/07. I have a couple questions I hope somebody can answer. My insurance has

determined my copay for my daughter's IVIG is $902. Can I submit that portion to

Medicaid? If so, do I just forward copies of the bill from the provider from now

on? What about bills already paid since August? Should I contact the hospital

where she receives her IVIG to let them know of Medicaid coverage and let them

bill Medicaid?It was a 7 month ordeal to get the insurance to agree to cover

IVIG. Will Medicaid be just as tough (or worse) to convince? Should I continue

to pay the copay and then hope Medicaid reimburses me? I'm sorry if this sounds

silly, but I have no idea how this works. The letter doesn't tell me much of

anything except they qualify and cards wil be issued later.Thanks for any

help![Non-text portions of this message have been

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January 6, 2008

---

In MI, our medicaid also picks up our cost after ins for

prescriptions. Its a big help, as our brand name cost is $40 each, and

with four kids with issues, plus myself, that adds up to more per

month than we even bring in. It will be the same as with the drs

office...just take your Medicaid card to your pharmacy, or if its the

out of state one, call and give them your Medicaid number. They should

take care of all of it for you.

valarie

In , " susan sorensen " <sorensens004@...> wrote:

>

> Thank you to everyone who responded! Looks like I'll be on the

phone tomorrow to quite a few people. One more question...Does

Medicaid cover prescriptions? If so, do I submit receipts to

Medicaid? I do not have prescription coverage on our health insurance

policy and although we do use Costco mostly, some of the kid's Rx's

are compounded out of state and need to be sent overnight on ice ($$$).

> Thanks again,

>

> Medicaid questions

>

> Hi,

>

> I just received a letter stating that my kids have qualified for

Medicaid and it would be retroactive to 8/07. I have a couple

questions I hope somebody can answer.

>

> My insurance has determined my copay for my daughter's IVIG is

$902. Can I submit that portion to Medicaid? If so, do I just forward

copies of the bill from the provider from now on? What about bills

already paid since August? Should I contact the hospital where she

receives her IVIG to let them know of Medicaid coverage and let them

bill Medicaid?

>

> It was a 7 month ordeal to get the insurance to agree to cover

IVIG. Will Medicaid be just as tough (or worse) to convince? Should I

continue to pay the copay and then hope Medicaid reimburses me?

>

> I'm sorry if this sounds silly, but I have no idea how this works.

The letter doesn't tell me much of anything except they qualify and

cards wil be issued later.

>

> Thanks for any help!

>

January 6, 2008

Give the company where you got the meds from your new insurance info and if you

say please please and let them know what is going on they may be willing to

rebill them to medicaid. and YES they do have RX coverage.

BARBIE

Medicaid questions

Hi,

I just received a letter stating that my kids have qualified for Medicaid and it

would be retroactive to 8/07. I have a couple questions I hope somebody can

answer.

My insurance has determined my copay for my daughter's IVIG is $902. Can I

submit that portion to Medicaid? If so, do I just forward copies of the bill

from the provider from now on? What about bills already paid since August?

Should I contact the hospital where she receives her IVIG to let them know of

Medicaid coverage and let them bill Medicaid?

It was a 7 month ordeal to get the insurance to agree to cover IVIG. Will

Medicaid be just as tough (or worse) to convince? Should I continue to pay the

copay and then hope Medicaid reimburses me?

I'm sorry if this sounds silly, but I have no idea how this works. The letter

doesn't tell me much of anything except they qualify and cards wil be issued

later.

Thanks for any help!

January 6, 2008

Here in SC with medicaid, the childre have unlimited perscriptions. But at age

21 they start paying 3 $$'s & are limited to 4 scripts. Check with YOUR

medicaid office on this one.

With Blake he has ins. if they don't pay it is automatically billed to

medicaid. The pharmacist can tell which they will pay for & which are not

covered. With Blake it is practically " tit for tat "

Hope this helps...I know having the extra ins. is a BIG help!!!!

Mom to Blake 15

SCID, Asperger's, Sensory Intergration Motor Skills Delays, Central Auditory

Processing Deffecit ,Gentetic Prothrombin Deffect, Factor V Leiden & MTHRF DNA

Deffect. Straight A's in 9th grade!!!!

http://www3.caringbridge.org/sc/blakester

The Greatest Adventure of MY Lifetime!!!!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

susan sorensen <sorensens004@...> wrote:

Thank you to everyone who responded! Looks like I'll be on the phone

tomorrow to quite a few people. One more question...Does Medicaid cover

prescriptions? If so, do I submit receipts to Medicaid? I do not have

prescription coverage on our health insurance policy and although we do use

Costco mostly, some of the kid's Rx's are compounded out of state and need to be

sent overnight on ice ($$$).

Thanks again,

Medicaid questions

Hi,

I just received a letter stating that my kids have qualified for Medicaid and it

would be retroactive to 8/07. I have a couple questions I hope somebody can

answer.

My insurance has determined my copay for my daughter's IVIG is $902. Can I

submit that portion to Medicaid? If so, do I just forward copies of the bill

from the provider from now on? What about bills already paid since August?

Should I contact the hospital where she receives her IVIG to let them know of

Medicaid coverage and let them bill Medicaid?

It was a 7 month ordeal to get the insurance to agree to cover IVIG. Will

Medicaid be just as tough (or worse) to convince? Should I continue to pay the

copay and then hope Medicaid reimburses me?

I'm sorry if this sounds silly, but I have no idea how this works. The letter

doesn't tell me much of anything except they qualify and cards wil be issued

later.

Thanks for any help!

January 7, 2008

Hi Barbie

Yep!!! I had to go to court twice for him to just get medicaid.

We were denied SSI because of 's income. He was making $80-

90,000

(LOTS of overtime) I was told from the beginning to LET SSI deny him

&

apply through the TEFRA Act. That is what I did. That was When

Blake

was 4. He had had 3 surgeries just in 1995(age 3). This was also when

they decided to test the immune system......It FAILED!!!! He had to

have a central line placed & used ONLY IV antibiotics. But it was the

Immuno. we used at that time that told everyone involved in Blake's

care that it was NOT his immune sytem failing that he had too many

irons in the fire & she believed all hearts against hearts he WOULD

out grow it.....give him time....he was born weighing only 1 lb. 6oz

&

lost more than 50 % of body weight in the first couple of days of life

Well how does that play into a 3-4 yr. old hwo gets sick each time he

is near any other child let alone his grand-parents. We swithced Drs.

Any way, the reason we went to court about the Medicaid was to proove

WHY Blake needed the secondary ins. Just because Dad over worked this

yr. did not mean he would next yr. Plus the medicaid office and

vocational rehab kept telling that with all the therapy, asthma

feeding tubes central lines & such, he COULD function as an adult.

right after that review came back, I was livid!!! I got on the phone

&

put in my appeal right away. This first time I had to write a letter

explaining what it was like to like with an Autistic/ADHD/OCD/ODD NOS

boy living in a bubble & not know when the next infection would set

in, not know what day he will be in the hospital. What time of the

day

we would have to deal with a MAJOR " melt down " all because the cereal

was not totally covered with milk not to mention having to clean up

toys shewn across the floor all because they would not line up the

way

they should. Then deal with IV antibiotics needing to be started

every

8 hrs. To top it off having a feeding tube we had to keep hooked to a

pump to maintain a guestamated weight because your child would not

eat

adequate amt to keep the label FTT off his plate.

The Judge totally agreed with me & that is when the Medicaid was

retro

to the beginnig of 1995. That was 18 mos. before this court " date " .

The second time we again had to deal with the way the Dr. worded

Blake's health....we by then had a different Immuno plus a Pulmo. &

it

was mandatory for a review of his TEFRA(4 YRS, So, Blake was 8). This

time Blake was actually in the hospital & had been there for 4

months!!!! It has NEVER been a question again.

I just fill out the medicaid form & don't have to worry

Now that Dad has decided he would have a younger woman on his side &

be into her lifestyle, Blake & I were actally put out on our own with

no husband to support us(long story & not done in court) I applied

right away for SSI. they did not hesitate to get SSI going!!! When I

did, a lot of doors were opened to me &

Blake. Even our church was in the dark of all we were enduring

because of dad's parents NOT wanting to admit Blake was as medically

fragile as he is. But they made no bones to tell them about our

split!!! The Church has set up folks to help me & Blake financially &

make sure I have what is needed to get Blake ahead!!!

It is amazing what people will do when they learn of the WHOLE

picture

& we finally admit that we need the help!!! We were able to go back

to

2 yrs. ago & collect all of that. But am still ready to do battle !!!!

Sorry this was too long, if you are still here & reading Thanks!!

Mom to Blake, 16, SCID with Complete T-Cell

Dysfunction.....lots

of other stuff, too!!

http://www3.caringbridge.org/sc/blakester

The Greatest Adventure of MY Lifetime!!!!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~

>

> Hi , my son just got SSI and the judge wrote on his approval

that it was suppose to be retro to his birth. That would be a

nightmare for everyone if it included his medical bills. All I would

like is payment to make up for some I have had to put out. Any way my

question is that when I talked to SSI they told me that it would only

go to the date we applied. It sounds like you went to court for his

MEDICAID but it he also on Social Security?

>

> BARBIE

January 7, 2008

Hi ,

Just wanted to add that, at least here in Massachusetts, Medicaid will also

cover many over the counter meds for kids as well-- as long as you have a

prescription from the doctor. We no longer pay for tylenol, benadryl,

ibuprofen, multi-vitimins, even A & D ointment is covered as well, and with no

co-pay. Many people don't know that Medicaid also pays for these items too, so

just thought I'd throw that out there too. We only recently found out and

between all three kids with issues and infusions for all three each week, we

save about $85 a month just on over the counter stuff. We got a list of the

covered OTC meds from our caseworker, and then emailed our immunologist with a

list of which ones we use regularly. He mailed me the srcipts-- it was very

easy.

Good Luck!

, mom to: (8) CVID, Asthma, Siezures, Neutropenia? (5)

CVID, Asthma, Neutropenia? (2) CVID, Asthma, NeutropeniaOUR STORY:

http://foxfamilypidd.bravehost.com/

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Share life as it happens with the new Windows Live.

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January 7, 2008

thanks so much -Marie,

I am not sure what will be made of it but the first time I asked for a hearing

in WA state it took over 3 years to get the hearing and we had moved to OK. So I

am not sure what it will take now that he has officially been approved. They are

driving me crazy because they are asking me to go back and recreate the last 4

years of my life so they can verify how his money was spent and how I used my

money and how it related to loans etc. So he was approved in August officially

but I have not seen a dime yet. It is a bit difficult for now. I too am a

single mom now which I understand is quite common for families with high risk

kids or kids with chronic health care issues. I do not want to be prejudice but

I guess it takes us tough moms to hang in there.

BARBIE

Re: Medicaid questions

Hi Barbie

Yep!!! I had to go to court twice for him to just get medicaid.

We were denied SSI because of 's income. He was making $80-

90,000

(LOTS of overtime) I was told from the beginning to LET SSI deny him

&

apply through the TEFRA Act. That is what I did. That was When

Blake

was 4. He had had 3 surgeries just in 1995(age 3). This was also when

they decided to test the immune system...... It FAILED!!!! He had to