Re: HIPP Denial

[Guest guest]

I was denied at one point as well when our family premium went up about 150 a month. I was able to negotiate with HIPP. And they agreed to continue to reimburse at previous rate. I thought...duh! I mean they were paying that amount already.

To: Texas-Autism-Advocacy Sent: Tuesday, December 30, 2008 7:37:42 AMSubject: HIPP Denial

Our HIPP request was also denied, but we appealed and got it. When the state looks at whether or not it’s cost-effective to reimburse you, they need to consider your child’s claims experience (utilization) . My son, , is a high utilizer, which is why we pay such high premiums. It’s more cost-effective for the state to reimburse us the insurance premium amount instead of Medicaid having to pay for all of his high claims. Before you appeal, you need to gather up all your EOBs from the last 12 months to submit to the state (you can get them from your insurer). If your child’s total claims for the last year exceed the amount of premiums you paid, it’s cost-effective for the state to reimburse you.

If the appeal fails…I would try to keep your child covered on insurance for as long as you can afford it for these reasons:

For any reason, if your child needs insurance in the future, he/she might be uninsurable if he does not already have insurance coverage.

Some things (such as ABA ) might be covered by insurance but not covered by Medicaid.

The providers of your choice might not accept Medicaid.

Your child still has Medicaid secondary, so things that are denied by your insurance could still be covered by Medicaid.

Geraldine