Re: Please educate me - did I make a stupid mistake?

[Guest guest]

--- mark colditz wrote:

> Everything was going fine, and I, out of ignorance, thought maybe

> Medicaid would help me lower costs, especially the blood tests to

> check the SSRI liver/kidney issues.

>

> Then, once they heard me say " Medicaid " they immediately declined

> services to me. My doctor was not involved. I never got past the

> Office Manager. She said sorry, we can't. I wish I had never

> said " Medicaid "

>

> I need a big dose of " educating " .

Hi Mark~

Medicaid in Texas is practically broke. They probably won't pay. If you don't

find

out ahead of time (i.e. specifically choose a doctor who accepts Medicaid)

you're up a

creek. Medicaid is not universal, it's a provider network, doctors don't have

to

accpet it if they choose not to. Emergency rooms and the like are required to

treat

you if you don't have other insurance, but private-practice physicians aren't.

If you want to go back to your doctor, you need to make sure the office manager

understands that the Medicaid is SECONDARY and you'll still be paying your

copays,

etc., if they don't accept Medicaid. If you want to switch doctors, make sure

you

choose one who accepts Medicaid (i.e. is prepared to write off copays and

whatever

your primary insurance doesn't cover) and is also on your primary insurance

network.

It's much easier that way.

Good luck!

Love,

Diane.

http://babiesonline.com/babies/e/evankyle

__________________________________________________

[Guest guest]

Do you have private insurance.maybe sign up for HIPP (Health Insurance

Premium Program)? Then he could have both insurances (private is primary

and Medicaid is secondary).

_____

From: Texas-Autism-Advocacy

[mailto:Texas-Autism-Advocacy ] On Behalf Of mark colditz

Sent: Friday, September 01, 2006 11:26 AM

To: Texas-Autism-Advocacy

Subject: Please educate me - did I make a stupid

mistake?

To all,

Recently, a few things changed in my life:

1. We now are receiving SSI and Medicaid benefits

2. We had to change our General Practice doctor for my son (was

hoping to use my doctor, because he is closer)

3. I am trying to reduce the amount of SSRI my son takes - my

Psychiatrist is NOT really supporting me, but I differ that my son

is stabilized for a year plus, thus I thought the amount of SSRI

could be reduced. In another words, no OCD, then a " maintenance "

program instead of " intervention " treatment could be possible.

4. I have guardianship May 2006.

Anyways, I go to the office this morning for an 11 am doctor visit.

My son is covered under my insurance plan until 21 years of age

(though Guardianship will probably extend it)

Everything was going fine, and I, out of ignorance, thought maybe

Medicaid would help me lower costs, especially the blood tests to

check the SSRI liver/kidney issues.

Then, once they heard me say " Medicaid " they immediately declined

services to me. My doctor was not involved. I never got past the

Office Manager. She said sorry, we can't. I wish I had never

said " Medicaid "

I need a big dose of " educating " .

Mark

[Guest guest]

--- " H. " wrote:

> Do you have private insurance.maybe sign up for HIPP (Health Insurance

> Premium Program)? Then he could have both insurances (private is primary

> and Medicaid is secondary).

Bingo!

Call (can you tell I've dealt with them a bunch??) and see if you

qualify

for HIPP. Your deductible has to be below $1000 and your premuims have to be

financially not a strain for them (I can't remember the term) and they'll

usually pay

your premiums for your whole family. That'll pay for the liver and kidney

tests.

Love,

Diane.

http://babiesonline.com/babies/e/evankyle

__________________________________________________

[Guest guest]

This is my personal experience. My son is 33 and is covered under my

husband's insurance plus he has medicaid. Medicaid is secondary. But

there are stupid laws- even though the private insurance is paying

most of the bill we cannot go to any Dr. that doesn't accept

medicaid. I tried and I got the same reaction from the office that

you did. It's a Catch 22. You're trying to save the State money but

you still have to play by their rules.

I used to have trouble with prescriptions because most pharmacies

wouldn't bill 2 places but now CVS will bill both and I get his

medicine with no cost and less hassle.

You don't have to have guardianship to keep your son on your

insurance. We don't have guardianship- we just had to prove his

disability and they continued to cover him. My husband changed

companies last year and we had to prove disability plus show that the

last co. covered him.

Hope this helps.

>

> To all,

>

> Recently, a few things changed in my life:

> 1. We now are receiving SSI and Medicaid benefits

> 2. We had to change our General Practice doctor for my son (was

> hoping to use my doctor, because he is closer)

> 3. I am trying to reduce the amount of SSRI my son takes - my

> Psychiatrist is NOT really supporting me, but I differ that my son

> is stabilized for a year plus, thus I thought the amount of SSRI

> could be reduced. In another words, no OCD, then a " maintenance "

> program instead of " intervention " treatment could be possible.

> 4. I have guardianship May 2006.

>

> Anyways, I go to the office this morning for an 11 am doctor

visit.

> My son is covered under my insurance plan until 21 years of age

> (though Guardianship will probably extend it)

>

> Everything was going fine, and I, out of ignorance, thought maybe

> Medicaid would help me lower costs, especially the blood tests to

> check the SSRI liver/kidney issues.

>

> Then, once they heard me say " Medicaid " they immediately declined

> services to me. My doctor was not involved. I never got past the

> Office Manager. She said sorry, we can't. I wish I had never

> said " Medicaid "

>

> I need a big dose of " educating " .

>

> Mark

>

[Guest guest]

Ooooo, THIS sounds like an issue that Senator Judith Zaffirini would be VERY

interested

in knowing about. http://www.zaffirini.senate.state.tx.us/

She is one of the most active Texas senators regarding issues of Medicaid

waivers and

persons with disabilities. Her health staff person told me that they are

VERY interested to

know when there are rules like this that make the process harder or more

expensive that

could be fixed. I think it would be worth calling them and having a

conversation with the

health aide as to WHAT could be done to fix that problem.

S.

Re: Please educate me - did I make a

stupid mistake?

This is my personal experience. My son is 33 and is covered under my

husband's insurance plus he has medicaid. Medicaid is secondary. But

there are stupid laws- even though the private insurance is paying

most of the bill we cannot go to any Dr. that doesn't accept

medicaid. I tried and I got the same reaction from the office that

you did. It's a Catch 22. You're trying to save the State money but

you still have to play by their rules.

I used to have trouble with prescriptions because most pharmacies

wouldn't bill 2 places but now CVS will bill both and I get his

medicine with no cost and less hassle.

You don't have to have guardianship to keep your son on your

insurance. We don't have guardianship- we just had to prove his

disability and they continued to cover him. My husband changed

companies last year and we had to prove disability plus show that the

last co. covered him.

Hope this helps.

>

> To all,

>

> Recently, a few things changed in my life:

> 1. We now are receiving SSI and Medicaid benefits

> 2. We had to change our General Practice doctor for my son (was

> hoping to use my doctor, because he is closer)

> 3. I am trying to reduce the amount of SSRI my son takes - my

> Psychiatrist is NOT really supporting me, but I differ that my son

> is stabilized for a year plus, thus I thought the amount of SSRI

> could be reduced. In another words, no OCD, then a " maintenance "

> program instead of " intervention " treatment could be possible.

> 4. I have guardianship May 2006.

>

> Anyways, I go to the office this morning for an 11 am doctor

visit.

> My son is covered under my insurance plan until 21 years of age

> (though Guardianship will probably extend it)

>

> Everything was going fine, and I, out of ignorance, thought maybe

> Medicaid would help me lower costs, especially the blood tests to

> check the SSRI liver/kidney issues.

>

> Then, once they heard me say " Medicaid " they immediately declined

> services to me. My doctor was not involved. I never got past the

> Office Manager. She said sorry, we can't. I wish I had never

> said " Medicaid "

>

> I need a big dose of " educating " .

>

> Mark

>

[Guest guest]

Hi ,

I will call Senator Zaffirini and will explain my story.

I hope it will help.

Yesterday was shock. Today I am feverishly yanking weeds out of my

flower beds (garden therapy).......I am looking forward to the

Monarchs coming soon to visit my Mexican zinnias........A cold beer

and sunset too........:>)

Mark

In Texas-Autism-Advocacy , " Singleton "

wrote:

>

> Ooooo, THIS sounds like an issue that Senator Judith Zaffirini

would be VERY

> interested

> in knowing about. http://www.zaffirini.senate.state.tx.us/

>

> She is one of the most active Texas senators regarding issues of

Medicaid

> waivers and

> persons with disabilities. Her health staff person told me that

they are

> VERY interested to

> know when there are rules like this that make the process harder or

more

> expensive that

> could be fixed. I think it would be worth calling them and having a

> conversation with the

> health aide as to WHAT could be done to fix that problem.

> S.

> Re: Please educate me - did I

make a

> stupid mistake?

>

>

> This is my personal experience. My son is 33 and is covered under

my

> husband's insurance plus he has medicaid. Medicaid is secondary.

But

> there are stupid laws- even though the private insurance is paying

> most of the bill we cannot go to any Dr. that doesn't accept

> medicaid. I tried and I got the same reaction from the office that

> you did. It's a Catch 22. You're trying to save the State money

but

> you still have to play by their rules.

>

> I used to have trouble with prescriptions because most pharmacies

> wouldn't bill 2 places but now CVS will bill both and I get his

> medicine with no cost and less hassle.

>

> You don't have to have guardianship to keep your son on your

> insurance. We don't have guardianship- we just had to prove his

> disability and they continued to cover him. My husband changed

> companies last year and we had to prove disability plus show that

the

> last co. covered him.

> Hope this helps.

>

>

> >

> > To all,

> >

> > Recently, a few things changed in my life:

> > 1. We now are receiving SSI and Medicaid benefits

> > 2. We had to change our General Practice doctor for my son (was

> > hoping to use my doctor, because he is closer)

> > 3. I am trying to reduce the amount of SSRI my son takes - my

> > Psychiatrist is NOT really supporting me, but I differ that my

son

> > is stabilized for a year plus, thus I thought the amount of SSRI

> > could be reduced. In another words, no OCD, then a " maintenance "

> > program instead of " intervention " treatment could be possible.

> > 4. I have guardianship May 2006.

> >

> > Anyways, I go to the office this morning for an 11 am doctor

> visit.

> > My son is covered under my insurance plan until 21 years of age

> > (though Guardianship will probably extend it)

> >

> > Everything was going fine, and I, out of ignorance, thought

maybe

> > Medicaid would help me lower costs, especially the blood tests

to

> > check the SSRI liver/kidney issues.

> >

> > Then, once they heard me say " Medicaid " they immediately

declined

> > services to me. My doctor was not involved. I never got past the

> > Office Manager. She said sorry, we can't. I wish I had never

> > said " Medicaid "

> >

> > I need a big dose of " educating " .

> >

> > Mark

> >

>

>

>

>

>

>

>