Guest guest Posted December 30, 2008 Report Share Posted December 30, 2008 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2008 Report Share Posted December 30, 2008 We submitted his EOBs but there weren't many claims last year. I'm sure looking at last year alone would show not cost effective. We'll keep him on our insurance and try again next year I guess. > > 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 > Quote Link to comment Share on other sites More sharing options...
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