Guest guest Posted September 1, 2007 Report Share Posted September 1, 2007 I think the reason they can choose between a state regulated plan and a self insured plan is because company provided insurance is a fringe benefit and not a requirement. Maybe has a better explanation since she has been involved in this legislation. Tonya From: Texas-Autism-Advocacy [mailto:Texas-Autism-Advocacy ] On Behalf Of twinnfun Sent: Saturday, September 01, 2007 9:13 PM To: Texas-Autism-Advocacy Subject: INSURANCE QUESTION Could someone explain to me the reasoning behind the law that regulates self-funded insurance?!? We are insured by United Healthcare through Hewlett Packard which is therefore self funded and apparently regulated by federal law rather than Texas State Law but I really do not understand why the difference. If a company does business in a state, any state, they need to comply with a host of state laws so why are insurance companies excempt?!? For example Randall's is owned by Safeway which is headquartered in Oakland, CA. HOWEVER, their stores need to comply with health and safety codes, zoning laws, tax laws, and any other applicable regulation etc. here in Texas if they want to do business here in Texas - not just the federal law...So why does this philosophy not apply to all types of businesses, including health insurance? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 1, 2007 Report Share Posted September 1, 2007 I think the reason they can choose between a state regulated plan and a self insured plan is because company provided insurance is a fringe benefit and not a requirement. Maybe has a better explanation since she has been involved in this legislation. Tonya From: Texas-Autism-Advocacy [mailto:Texas-Autism-Advocacy ] On Behalf Of twinnfun Sent: Saturday, September 01, 2007 9:13 PM To: Texas-Autism-Advocacy Subject: INSURANCE QUESTION Could someone explain to me the reasoning behind the law that regulates self-funded insurance?!? We are insured by United Healthcare through Hewlett Packard which is therefore self funded and apparently regulated by federal law rather than Texas State Law but I really do not understand why the difference. If a company does business in a state, any state, they need to comply with a host of state laws so why are insurance companies excempt?!? For example Randall's is owned by Safeway which is headquartered in Oakland, CA. HOWEVER, their stores need to comply with health and safety codes, zoning laws, tax laws, and any other applicable regulation etc. here in Texas if they want to do business here in Texas - not just the federal law...So why does this philosophy not apply to all types of businesses, including health insurance? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 1, 2007 Report Share Posted September 1, 2007 I think the reason they can choose between a state regulated plan and a self insured plan is because company provided insurance is a fringe benefit and not a requirement. Maybe has a better explanation since she has been involved in this legislation. Tonya From: Texas-Autism-Advocacy [mailto:Texas-Autism-Advocacy ] On Behalf Of twinnfun Sent: Saturday, September 01, 2007 9:13 PM To: Texas-Autism-Advocacy Subject: INSURANCE QUESTION Could someone explain to me the reasoning behind the law that regulates self-funded insurance?!? We are insured by United Healthcare through Hewlett Packard which is therefore self funded and apparently regulated by federal law rather than Texas State Law but I really do not understand why the difference. If a company does business in a state, any state, they need to comply with a host of state laws so why are insurance companies excempt?!? For example Randall's is owned by Safeway which is headquartered in Oakland, CA. HOWEVER, their stores need to comply with health and safety codes, zoning laws, tax laws, and any other applicable regulation etc. here in Texas if they want to do business here in Texas - not just the federal law...So why does this philosophy not apply to all types of businesses, including health insurance? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 1, 2007 Report Share Posted September 1, 2007 There is a yahoo group: Autism_Insurance_Information that might be able to answer this question for you. twinnfun wrote: Could someone explain to me the reasoning behind the law that regulates self-funded insurance?!? We are insured by United Healthcare through Hewlett Packard which is therefore self funded and apparently regulated by federal law rather than Texas State Law but I really do not understand why the difference. If a company does business in a state, any state, they need to comply with a host of state laws so why are insurance companies excempt?!? For example Randall's is owned by Safeway which is headquartered in Oakland, CA. HOWEVER, their stores need to comply with health and safety codes, zoning laws, tax laws, and any other applicable regulation etc. here in Texas if they want to do business here in Texas - not just the federal law...So why does this philosophy not apply to all types of businesses, including health insurance? Fran K. atz99@... Think Autism,Think Cure! --------------------------------- Looking for a deal? Find great prices on flights and hotels with Yahoo! FareChase. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 1, 2007 Report Share Posted September 1, 2007 Insurance, like most things heavily regulated, is a maze of exceptions and contradictory rules that made sense when they were created, but have outlived their usefulness or need to be updated. Even updated rules can end up really screwy after they come out of a committee--ask any of the retired folks who are on Medicare and stuck in the " doughnut " -- the name for the time during which their medication cost has exceeded their allowable coverage and when the supplemental medication plan picks up (I think thats technically what it is.) I don't know the exact reasoning behind ERISA, the federal act that governs large companies who fund their own insurance plans BUT I do know that insurance is NOT the only thing covered under the law. ERISA also governs the rules. I bet if you google " history of ERISA " you will get some great info on it. BUT to date, the only people I know who have gotten their ABA programs fully funded for their kids with autism have ALL been under ERISA plans. So frankly, I don't really think the plans are bad--it what the company will agree to pay for. S. Re: INSURANCE QUESTION There is a yahoo group: Autism_Insurance_Information that might be able to answer this question for you. twinnfun wrote: Could someone explain to me the reasoning behind the law that regulates self-funded insurance?!? We are insured by United Healthcare through Hewlett Packard which is therefore self funded and apparently regulated by federal law rather than Texas State Law but I really do not understand why the difference. If a company does business in a state, any state, they need to comply with a host of state laws so why are insurance companies excempt?!? For example Randall's is owned by Safeway which is headquartered in Oakland, CA. HOWEVER, their stores need to comply with health and safety codes, zoning laws, tax laws, and any other applicable regulation etc. here in Texas if they want to do business here in Texas - not just the federal law...So why does this philosophy not apply to all types of businesses, including health insurance? Fran K. atz99@... Think Autism,Think Cure! --------------------------------- Looking for a deal? Find great prices on flights and hotels with Yahoo! FareChase. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2007 Report Share Posted September 3, 2007 According to our human resources department, it's " more cost effective. " In other words, it allows them to not cover anything that they don't want to cover.... As far as I know, all Houston area school districts have self funded plans... ________________________________________________________________________________\ ____ Yahoo! oneSearch: Finally, mobile search that gives answers, not web links. http://mobile.yahoo.com/mobileweb/onesearch?refer=1ONXIC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2007 Report Share Posted September 3, 2007 According to our human resources department, it's " more cost effective. " In other words, it allows them to not cover anything that they don't want to cover.... As far as I know, all Houston area school districts have self funded plans... ________________________________________________________________________________\ ____ Yahoo! oneSearch: Finally, mobile search that gives answers, not web links. http://mobile.yahoo.com/mobileweb/onesearch?refer=1ONXIC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2007 Report Share Posted September 3, 2007 According to our human resources department, it's " more cost effective. " In other words, it allows them to not cover anything that they don't want to cover.... As far as I know, all Houston area school districts have self funded plans... ________________________________________________________________________________\ ____ Yahoo! oneSearch: Finally, mobile search that gives answers, not web links. http://mobile.yahoo.com/mobileweb/onesearch?refer=1ONXIC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2012 Report Share Posted January 23, 2012 I have a random insurance question...andra (CVID, FG Syndrome) is under my husband's health insurance plan, since she is also a Regional client she qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any of you have both private insurance and state insurance. I am wondering if Medi-Cal would be more willing to finance referrals " outside of the system " ....I have no idea about any of this but we are desperately trying to get a referral to Cincinnati Children's. This has been dragging on for well over a year (maybe longer....I've lost track) now and we really cannot afford to finance the visit ourselves. Just wonder if anyone else has had experience with this. Thanks, Jeane Mom to andra 15 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2012 Report Share Posted January 23, 2012 Thanks for the input, Mindy....insurance is truly a blessing but there is definitely a down side to it all! On Mon, Jan 23, 2012 at 6:21 PM, <mindy@...> wrote: > ** > > > My son has BCBS and Virginia Medicaid. THis works well in-state, because > most of the time, Medicaid will cover our copays. We had to go > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't > cover any of it. If you are going to a " border " city, the hospital may > take your out-of-state Medicaid benefits, but you would have to actually > ask the providers if they will take it. Sorry... > > Mindy, mom to , 9, CVID+ > > > I have a random insurance question...andra (CVID, FG Syndrome) is > > under > > my husband's health insurance plan, since she is also a Regional client > > she > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any > > of > > you have both private insurance and state insurance. I am wondering if > > Medi-Cal would be more willing to finance referrals " outside of the > > system " ....I have no idea about any of this but we are desperately trying > > to get a referral to Cincinnati Children's. This has been dragging on > > for > > well over a year (maybe longer....I've lost track) now and we really > > cannot > > afford to finance the visit ourselves. Just wonder if anyone else has had > > experience with this. > > > > Thanks, > > > > Jeane > > Mom to andra 15 > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2012 Report Share Posted January 23, 2012 Thanks for the input, Mindy....insurance is truly a blessing but there is definitely a down side to it all! On Mon, Jan 23, 2012 at 6:21 PM, <mindy@...> wrote: > ** > > > My son has BCBS and Virginia Medicaid. THis works well in-state, because > most of the time, Medicaid will cover our copays. We had to go > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't > cover any of it. If you are going to a " border " city, the hospital may > take your out-of-state Medicaid benefits, but you would have to actually > ask the providers if they will take it. Sorry... > > Mindy, mom to , 9, CVID+ > > > I have a random insurance question...andra (CVID, FG Syndrome) is > > under > > my husband's health insurance plan, since she is also a Regional client > > she > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any > > of > > you have both private insurance and state insurance. I am wondering if > > Medi-Cal would be more willing to finance referrals " outside of the > > system " ....I have no idea about any of this but we are desperately trying > > to get a referral to Cincinnati Children's. This has been dragging on > > for > > well over a year (maybe longer....I've lost track) now and we really > > cannot > > afford to finance the visit ourselves. Just wonder if anyone else has had > > experience with this. > > > > Thanks, > > > > Jeane > > Mom to andra 15 > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, Makenzie 11 22 > > > ** > > > > > > My son has BCBS and Virginia Medicaid. THis works well in-state, because > > most of the time, Medicaid will cover our copays. We had to go > > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't > > cover any of it. If you are going to a " border " city, the hospital may > > take your out-of-state Medicaid benefits, but you would have to actually > > ask the providers if they will take it. Sorry... > > > > Mindy, mom to , 9, CVID+ > > > > > I have a random insurance question...andra (CVID, FG Syndrome) is > > > under > > > my husband's health insurance plan, since she is also a Regional client > > > she > > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any > > > of > > > you have both private insurance and state insurance. I am wondering if > > > Medi-Cal would be more willing to finance referrals " outside of the > > > system " ....I have no idea about any of this but we are desperately trying > > > to get a referral to Cincinnati Children's. This has been dragging on > > > for > > > well over a year (maybe longer....I've lost track) now and we really > > > cannot > > > afford to finance the visit ourselves. Just wonder if anyone else has had > > > experience with this. > > > > > > Thanks, > > > > > > Jeane > > > Mom to andra 15 > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, Makenzie 11 22 > > > ** > > > > > > My son has BCBS and Virginia Medicaid. THis works well in-state, because > > most of the time, Medicaid will cover our copays. We had to go > > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't > > cover any of it. If you are going to a " border " city, the hospital may > > take your out-of-state Medicaid benefits, but you would have to actually > > ask the providers if they will take it. Sorry... > > > > Mindy, mom to , 9, CVID+ > > > > > I have a random insurance question...andra (CVID, FG Syndrome) is > > > under > > > my husband's health insurance plan, since she is also a Regional client > > > she > > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any > > > of > > > you have both private insurance and state insurance. I am wondering if > > > Medi-Cal would be more willing to finance referrals " outside of the > > > system " ....I have no idea about any of this but we are desperately trying > > > to get a referral to Cincinnati Children's. This has been dragging on > > > for > > > well over a year (maybe longer....I've lost track) now and we really > > > cannot > > > afford to finance the visit ourselves. Just wonder if anyone else has had > > > experience with this. > > > > > > Thanks, > > > > > > Jeane > > > Mom to andra 15 > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 - BCMH does cover CVID. My son was just diagnosed and his therapy will be covered at 100%. Be sure the patient sees a BCMH provider... Re: Insurance Question Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, Makenzie 11 22 > > > ** > > > > > > My son has BCBS and Virginia Medicaid. THis works well in-state, because > > most of the time, Medicaid will cover our copays. We had to go > > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't > > cover any of it. If you are going to a " border " city, the hospital may > > take your out-of-state Medicaid benefits, but you would have to actually > > ask the providers if they will take it. Sorry... > > > > Mindy, mom to , 9, CVID+ > > > > > I have a random insurance question...andra (CVID, FG Syndrome) is > > > under > > > my husband's health insurance plan, since she is also a Regional client > > > she > > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any > > > of > > > you have both private insurance and state insurance. I am wondering if > > > Medi-Cal would be more willing to finance referrals " outside of the > > > system " ....I have no idea about any of this but we are desperately trying > > > to get a referral to Cincinnati Children's. This has been dragging on > > > for > > > well over a year (maybe longer....I've lost track) now and we really > > > cannot > > > afford to finance the visit ourselves. Just wonder if anyone else has had > > > experience with this. > > > > > > Thanks, > > > > > > Jeane > > > Mom to andra 15 > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 - BCMH does cover CVID. My son was just diagnosed and his therapy will be covered at 100%. Be sure the patient sees a BCMH provider... Re: Insurance Question Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, Makenzie 11 22 > > > ** > > > > > > My son has BCBS and Virginia Medicaid. THis works well in-state, because > > most of the time, Medicaid will cover our copays. We had to go > > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't > > cover any of it. If you are going to a " border " city, the hospital may > > take your out-of-state Medicaid benefits, but you would have to actually > > ask the providers if they will take it. Sorry... > > > > Mindy, mom to , 9, CVID+ > > > > > I have a random insurance question...andra (CVID, FG Syndrome) is > > > under > > > my husband's health insurance plan, since she is also a Regional client > > > she > > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any > > > of > > > you have both private insurance and state insurance. I am wondering if > > > Medi-Cal would be more willing to finance referrals " outside of the > > > system " ....I have no idea about any of this but we are desperately trying > > > to get a referral to Cincinnati Children's. This has been dragging on > > > for > > > well over a year (maybe longer....I've lost track) now and we really > > > cannot > > > afford to finance the visit ourselves. Just wonder if anyone else has had > > > experience with this. > > > > > > Thanks, > > > > > > Jeane > > > Mom to andra 15 > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 I'm not sure if this is relevant to you, but just to avoid sticker shock.  We have two forms of Blue Cross/Blue Shield, primary is of California, secondary is of Alabama.  Our first day visit with Dr. Bleesing was billed at $20,000.  He drew 22 vials of blood and much of that was to cover those lab tests.  There was also a very expensive Gallbladder study on that day.  They bill the insurance at the end of the day and they do not use line itemizations for each test, just an overall bill for the day.  Now, having scared you to death with that bill, my primary Blue Cross covered almost all of the bill.  Whatever agreement CCH has with Blue Cross, they are getting paid well.  I don't know yet what our out of pocket will be as the secondary is still outstanding. Hope that helps, Vickie From: Kookoo <nalla70@...> Subject: Re: Insurance Question Date: Tuesday, January 24, 2012, 9:13 AM  Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, Makenzie 11 22 > > > ** > > > > > > My son has BCBS and Virginia Medicaid. THis works well in-state, because > > most of the time, Medicaid will cover our copays. We had to go > > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't > > cover any of it. If you are going to a " border " city, the hospital may > > take your out-of-state Medicaid benefits, but you would have to actually > > ask the providers if they will take it. Sorry... > > > > Mindy, mom to , 9, CVID+ > > > > > I have a random insurance question...andra (CVID, FG Syndrome) is > > > under > > > my husband's health insurance plan, since she is also a Regional client > > > she > > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any > > > of > > > you have both private insurance and state insurance. I am wondering if > > > Medi-Cal would be more willing to finance referrals " outside of the > > > system " ....I have no idea about any of this but we are desperately trying > > > to get a referral to Cincinnati Children's. This has been dragging on > > > for > > > well over a year (maybe longer....I've lost track) now and we really > > > cannot > > > afford to finance the visit ourselves. Just wonder if anyone else has had > > > experience with this. > > > > > > Thanks, > > > > > > Jeane > > > Mom to andra 15 > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 I'm not sure if this is relevant to you, but just to avoid sticker shock.  We have two forms of Blue Cross/Blue Shield, primary is of California, secondary is of Alabama.  Our first day visit with Dr. Bleesing was billed at $20,000.  He drew 22 vials of blood and much of that was to cover those lab tests.  There was also a very expensive Gallbladder study on that day.  They bill the insurance at the end of the day and they do not use line itemizations for each test, just an overall bill for the day.  Now, having scared you to death with that bill, my primary Blue Cross covered almost all of the bill.  Whatever agreement CCH has with Blue Cross, they are getting paid well.  I don't know yet what our out of pocket will be as the secondary is still outstanding. Hope that helps, Vickie From: Kookoo <nalla70@...> Subject: Re: Insurance Question Date: Tuesday, January 24, 2012, 9:13 AM  Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, Makenzie 11 22 > > > ** > > > > > > My son has BCBS and Virginia Medicaid. THis works well in-state, because > > most of the time, Medicaid will cover our copays. We had to go > > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't > > cover any of it. If you are going to a " border " city, the hospital may > > take your out-of-state Medicaid benefits, but you would have to actually > > ask the providers if they will take it. Sorry... > > > > Mindy, mom to , 9, CVID+ > > > > > I have a random insurance question...andra (CVID, FG Syndrome) is > > > under > > > my husband's health insurance plan, since she is also a Regional client > > > she > > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any > > > of > > > you have both private insurance and state insurance. I am wondering if > > > Medi-Cal would be more willing to finance referrals " outside of the > > > system " ....I have no idea about any of this but we are desperately trying > > > to get a referral to Cincinnati Children's. This has been dragging on > > > for > > > well over a year (maybe longer....I've lost track) now and we really > > > cannot > > > afford to finance the visit ourselves. Just wonder if anyone else has had > > > experience with this. > > > > > > Thanks, > > > > > > Jeane > > > Mom to andra 15 > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 From experience and from working with National Patient Advocacy Foundation I can tell you that a Medicaid plan will not pay for out of state care. The GREAT purpose for medicare would be to pick up your deductibles and copays in Ca that your primary insurance does not pay. A provider cannot charge you beyond what your primary insurance pays if you show them your medical card. You may be able to get your primary insurance to pay if you can prove to them that the care is not available in your state but I do not think they will believe that in a state like California with the level of care available there at UCLA, Stanford and other BIG University Hospitals. Sadly with the way our system is right now the ability to get care in other states is almost impossible. It is all about saving money and so if you have the financial resources is the only way to get the care out of state except for a consultation. It might be worthwhile to contact IDF to help you find a specialist to help you for the problems you are having specifically. There may be someone better aware of how to deal with her needs on a consultant basis even in an out of state institution. It would take working with someone to advocate for you or having the labs etc drawn in CA and having someone consult from out of state such as at the Cleveland Clinic. Is there a Pediatrician or Immunologist that could help you get the answers you are seeking? Barbie Lucas with CVID, Bipolar etc  BARBIE  >________________________________ > From: Kookoo <nalla70@...> > >Sent: Tuesday, January 24, 2012 9:13 AM >Subject: Re: Insurance Question > > > > > >Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, > >Makenzie 11 > 22 > > >> >> > ** >> > >> > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, because >> > most of the time, Medicaid will cover our copays. We had to go >> > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't >> > cover any of it. If you are going to a " border " city, the hospital may >> > take your out-of-state Medicaid benefits, but you would have to actually >> > ask the providers if they will take it. Sorry... >> > >> > Mindy, mom to , 9, CVID+ >> > >> > > I have a random insurance question...andra (CVID, FG Syndrome) is >> > > under >> > > my husband's health insurance plan, since she is also a Regional client >> > > she >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any >> > > of >> > > you have both private insurance and state insurance. I am wondering if >> > > Medi-Cal would be more willing to finance referrals " outside of the >> > > system " ....I have no idea about any of this but we are desperately trying >> > > to get a referral to Cincinnati Children's. This has been dragging on >> > > for >> > > well over a year (maybe longer....I've lost track) now and we really >> > > cannot >> > > afford to finance the visit ourselves. Just wonder if anyone else has had >> > > experience with this. >> > > >> > > Thanks, >> > > >> > > Jeane >> > > Mom to andra 15 >> > > >> > > >> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 From experience and from working with National Patient Advocacy Foundation I can tell you that a Medicaid plan will not pay for out of state care. The GREAT purpose for medicare would be to pick up your deductibles and copays in Ca that your primary insurance does not pay. A provider cannot charge you beyond what your primary insurance pays if you show them your medical card. You may be able to get your primary insurance to pay if you can prove to them that the care is not available in your state but I do not think they will believe that in a state like California with the level of care available there at UCLA, Stanford and other BIG University Hospitals. Sadly with the way our system is right now the ability to get care in other states is almost impossible. It is all about saving money and so if you have the financial resources is the only way to get the care out of state except for a consultation. It might be worthwhile to contact IDF to help you find a specialist to help you for the problems you are having specifically. There may be someone better aware of how to deal with her needs on a consultant basis even in an out of state institution. It would take working with someone to advocate for you or having the labs etc drawn in CA and having someone consult from out of state such as at the Cleveland Clinic. Is there a Pediatrician or Immunologist that could help you get the answers you are seeking? Barbie Lucas with CVID, Bipolar etc  BARBIE  >________________________________ > From: Kookoo <nalla70@...> > >Sent: Tuesday, January 24, 2012 9:13 AM >Subject: Re: Insurance Question > > > > > >Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, > >Makenzie 11 > 22 > > >> >> > ** >> > >> > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, because >> > most of the time, Medicaid will cover our copays. We had to go >> > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't >> > cover any of it. If you are going to a " border " city, the hospital may >> > take your out-of-state Medicaid benefits, but you would have to actually >> > ask the providers if they will take it. Sorry... >> > >> > Mindy, mom to , 9, CVID+ >> > >> > > I have a random insurance question...andra (CVID, FG Syndrome) is >> > > under >> > > my husband's health insurance plan, since she is also a Regional client >> > > she >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any >> > > of >> > > you have both private insurance and state insurance. I am wondering if >> > > Medi-Cal would be more willing to finance referrals " outside of the >> > > system " ....I have no idea about any of this but we are desperately trying >> > > to get a referral to Cincinnati Children's. This has been dragging on >> > > for >> > > well over a year (maybe longer....I've lost track) now and we really >> > > cannot >> > > afford to finance the visit ourselves. Just wonder if anyone else has had >> > > experience with this. >> > > >> > > Thanks, >> > > >> > > Jeane >> > > Mom to andra 15 >> > > >> > > >> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 Yikes! $20,000....Well, we do have the option with our insurance to choose a PPO with Blue Cross but the premiums are staggering....about $1000 more a month than what we are paying now, since my husband works for a healthcare company that self-insures they really try to make it undesirable to choose Blue Cross over the company insurance....soooo frustrating! Well, paying out of pocket sounds a little daunting, if not impossible for us. Thanks for the heads up on the cost of a Cincinnati visit! Jeane On Tue, Jan 24, 2012 at 10:37 AM, Vickie <victoriatfoster@...>wrote: > ** > > > I'm not sure if this is relevant to you, but just to avoid sticker shock. > We have two forms of Blue Cross/Blue Shield, primary is of California, > secondary is of Alabama. Our first day visit with Dr. Bleesing was billed > at $20,000. He drew 22 vials of blood and much of that was to cover those > lab tests. There was also a very expensive Gallbladder study on that day. > They bill the insurance at the end of the day and they do not use line > itemizations for each test, just an overall bill for the day. Now, having > scared you to death with that bill, my primary Blue Cross covered almost > all of the bill. Whatever agreement CCH has with Blue Cross, they are > getting paid well. I don't know yet what our out of pocket will be as the > secondary is still outstanding. > Hope that helps, > Vickie > > > > From: Kookoo <nalla70@...> > Subject: Re: Insurance Question > > Date: Tuesday, January 24, 2012, 9:13 AM > > > > Not sure on all that, but I wonder how so many get their kids to even > qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to > anyone who knows ) I believe we make too much to qualify Makenzie for > Medicaid (I think that is what she would get?) so we have insurance, but > pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it > gets very expensive, looking at my checkbook normal people would crap lol, > > > > Makenzie 11 > > 22 > > > > > > > > > ** > > > > > > > > > > > > My son has BCBS and Virginia Medicaid. THis works well in-state, > because > > > > most of the time, Medicaid will cover our copays. We had to go > > > > out-of-state (to Atlanta) for testing last year, and the Medicaid > didn't > > > > cover any of it. If you are going to a " border " city, the hospital may > > > > take your out-of-state Medicaid benefits, but you would have to > actually > > > > ask the providers if they will take it. Sorry... > > > > > > > > Mindy, mom to , 9, CVID+ > > > > > > > > > I have a random insurance question...andra (CVID, FG Syndrome) is > > > > > under > > > > > my husband's health insurance plan, since she is also a Regional > client > > > > > she > > > > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do > any > > > > > of > > > > > you have both private insurance and state insurance. I am wondering > if > > > > > Medi-Cal would be more willing to finance referrals " outside of the > > > > > system " ....I have no idea about any of this but we are desperately > trying > > > > > to get a referral to Cincinnati Children's. This has been dragging on > > > > > for > > > > > well over a year (maybe longer....I've lost track) now and we really > > > > > cannot > > > > > afford to finance the visit ourselves. Just wonder if anyone else > has had > > > > > experience with this. > > > > > > > > > > Thanks, > > > > > > > > > > Jeane > > > > > Mom to andra 15 > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 Yikes! $20,000....Well, we do have the option with our insurance to choose a PPO with Blue Cross but the premiums are staggering....about $1000 more a month than what we are paying now, since my husband works for a healthcare company that self-insures they really try to make it undesirable to choose Blue Cross over the company insurance....soooo frustrating! Well, paying out of pocket sounds a little daunting, if not impossible for us. Thanks for the heads up on the cost of a Cincinnati visit! Jeane On Tue, Jan 24, 2012 at 10:37 AM, Vickie <victoriatfoster@...>wrote: > ** > > > I'm not sure if this is relevant to you, but just to avoid sticker shock. > We have two forms of Blue Cross/Blue Shield, primary is of California, > secondary is of Alabama. Our first day visit with Dr. Bleesing was billed > at $20,000. He drew 22 vials of blood and much of that was to cover those > lab tests. There was also a very expensive Gallbladder study on that day. > They bill the insurance at the end of the day and they do not use line > itemizations for each test, just an overall bill for the day. Now, having > scared you to death with that bill, my primary Blue Cross covered almost > all of the bill. Whatever agreement CCH has with Blue Cross, they are > getting paid well. I don't know yet what our out of pocket will be as the > secondary is still outstanding. > Hope that helps, > Vickie > > > > From: Kookoo <nalla70@...> > Subject: Re: Insurance Question > > Date: Tuesday, January 24, 2012, 9:13 AM > > > > Not sure on all that, but I wonder how so many get their kids to even > qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to > anyone who knows ) I believe we make too much to qualify Makenzie for > Medicaid (I think that is what she would get?) so we have insurance, but > pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it > gets very expensive, looking at my checkbook normal people would crap lol, > > > > Makenzie 11 > > 22 > > > > > > > > > ** > > > > > > > > > > > > My son has BCBS and Virginia Medicaid. THis works well in-state, > because > > > > most of the time, Medicaid will cover our copays. We had to go > > > > out-of-state (to Atlanta) for testing last year, and the Medicaid > didn't > > > > cover any of it. If you are going to a " border " city, the hospital may > > > > take your out-of-state Medicaid benefits, but you would have to > actually > > > > ask the providers if they will take it. Sorry... > > > > > > > > Mindy, mom to , 9, CVID+ > > > > > > > > > I have a random insurance question...andra (CVID, FG Syndrome) is > > > > > under > > > > > my husband's health insurance plan, since she is also a Regional > client > > > > > she > > > > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do > any > > > > > of > > > > > you have both private insurance and state insurance. I am wondering > if > > > > > Medi-Cal would be more willing to finance referrals " outside of the > > > > > system " ....I have no idea about any of this but we are desperately > trying > > > > > to get a referral to Cincinnati Children's. This has been dragging on > > > > > for > > > > > well over a year (maybe longer....I've lost track) now and we really > > > > > cannot > > > > > afford to finance the visit ourselves. Just wonder if anyone else > has had > > > > > experience with this. > > > > > > > > > > Thanks, > > > > > > > > > > Jeane > > > > > Mom to andra 15 > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 Thanks, Barbie for the information....I guess we will go back to the drawing board....unfortunately our pediatrician has washed her hands of helping me. We are currently trying to find another one. She was the one who struck the final death blow to our request to go to Cincinnati, she withdrew her support and told the insurance company that andra did not have a bone marrow failure issue, that her counts were stable (despite the evidence of all the CBC's/BMB that have been done). Our immunologist is the one pushing us to go for more opinions but when it comes right down to us getting a letter of support for this referral he has never produced one and has never been available to talk to the insurance company....the list goes on and on. I feel like I'm beating my head against the wall! Jeane On Tue, Jan 24, 2012 at 1:21 PM, Barbara Jimenez <mother5590@...>wrote: > ** > > > From experience and from working with National Patient Advocacy Foundation > I can > tell you that a Medicaid plan will not pay for out of state care. The > GREAT > purpose for medicare would be to pick up your deductibles and copays in Ca > that > your primary insurance does not pay. A provider cannot charge you beyond > what > your primary insurance pays if you show them your medical card. You may be > able > to get your primary insurance to pay if you can prove to them that the > care is > not available in your state but I do not think they will believe that in a > state > like California with the level of care available there at UCLA, Stanford > and > other BIG University Hospitals. Sadly with the way our system is right now > the > ability to get care in other states is almost impossible. It is all about > saving > money and so if you have the financial resources is the only way to get > the > care out of state except for a consultation. It might be worthwhile to > contact > IDF to help you find a specialist to help you for the problems you are > having > specifically. There may be someone better aware of how to deal with her > needs on > a consultant basis even in an out of state institution. It would take > working > with someone to advocate for you or having the labs etc drawn in CA and > having > someone consult from out of state such as at the Cleveland Clinic. Is > there > a Pediatrician or Immunologist that could help you get the answers you are > seeking? > Barbie > Lucas with CVID, Bipolar etc > > > BARBIE > > >________________________________ > > From: Kookoo <nalla70@...> > > > >Sent: Tuesday, January 24, 2012 9:13 AM > >Subject: Re: Insurance Question > > > > > > > > > > > >Not sure on all that, but I wonder how so many get their kids to even > qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to > anyone who knows ) I believe we make too much to qualify Makenzie for > Medicaid (I think that is what she would get?) so we have insurance, but > pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it > gets very expensive, looking at my checkbook normal people would crap lol, > > > >Makenzie 11 > > 22 > > > > > >> > >> > ** > >> > > >> > > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, > because > >> > most of the time, Medicaid will cover our copays. We had to go > >> > out-of-state (to Atlanta) for testing last year, and the Medicaid > didn't > >> > cover any of it. If you are going to a " border " city, the hospital may > >> > take your out-of-state Medicaid benefits, but you would have to > actually > >> > ask the providers if they will take it. Sorry... > >> > > >> > Mindy, mom to , 9, CVID+ > >> > > >> > > I have a random insurance question...andra (CVID, FG Syndrome) > is > >> > > under > >> > > my husband's health insurance plan, since she is also a Regional > client > >> > > she > >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do > any > >> > > of > >> > > you have both private insurance and state insurance. I am wondering > if > >> > > Medi-Cal would be more willing to finance referrals " outside of the > >> > > system " ....I have no idea about any of this but we are desperately > trying > >> > > to get a referral to Cincinnati Children's. This has been dragging > on > >> > > for > >> > > well over a year (maybe longer....I've lost track) now and we really > >> > > cannot > >> > > afford to finance the visit ourselves. Just wonder if anyone else > has had > >> > > experience with this. > >> > > > >> > > Thanks, > >> > > > >> > > Jeane > >> > > Mom to andra 15 > >> > > > >> > > > >> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 The good thing is that the immunologist is the one that is concerned. I would ask for a case manager with the insurance. Then.... I would explain the situation to the case manager and then..... I would ask the insurance what they need to follow the requests from the Immunologist. I would then.... go back to the Immunologist and ask VERY specifically what he thinks he needs for her care. If it is a referral to a specific place then he needs to write a letter. I would ask when you can pick it up etc. You will then find out if he is just talking or really feels you need to get more care somewhere else. Either way I would get a second opinion somewhere at a University setting or Childrens Hospital. YOU will have to be the one to orchestrate this because no one else will do it. IF..... the Care Manager does not seem to know what they are doing then I would go to the head of the department usually an RN. Then you go to the Medical Director. I have done this with several cases over the years and it will work. I am an RN as well as have worked with insurance companies. The last thing they want to do is have her get sicker. They may come back with an alternative place to be seen but that is OK just do it. I would appeal everything in writing following their guidelines. They will take it up the ladder since there is a process by law for appeals that go up the ladder. Feel free to contact me directly if I can help. Barbie > > From: maryjeanedavis@... > Date: Tue, 24 Jan 2012 15:30:07 -0800 > Subject: Re: Re: Insurance Question > > Thanks, Barbie for the information....I guess we will go back to the > drawing board....unfortunately our pediatrician has washed her hands of > helping me. We are currently trying to find another one. She was the one > who struck the final death blow to our request to go to Cincinnati, she > withdrew her support and told the insurance company that andra did not > have a bone marrow failure issue, that her counts were stable (despite the > evidence of all the CBC's/BMB that have been done). Our immunologist is > the one pushing us to go for more opinions but when it comes right down to > us getting a letter of support for this referral he has never produced one > and has never been available to talk to the insurance company....the list > goes on and on. I feel like I'm beating my head against the wall! > > Jeane > > On Tue, Jan 24, 2012 at 1:21 PM, Barbara Jimenez <mother5590@...>wrote: > > > ** > > > > > > From experience and from working with National Patient Advocacy Foundation > > I can > > tell you that a Medicaid plan will not pay for out of state care. The > > GREAT > > purpose for medicare would be to pick up your deductibles and copays in Ca > > that > > your primary insurance does not pay. A provider cannot charge you beyond > > what > > your primary insurance pays if you show them your medical card. You may be > > able > > to get your primary insurance to pay if you can prove to them that the > > care is > > not available in your state but I do not think they will believe that in a > > state > > like California with the level of care available there at UCLA, Stanford > > and > > other BIG University Hospitals. Sadly with the way our system is right now > > the > > ability to get care in other states is almost impossible. It is all about > > saving > > money and so if you have the financial resources is the only way to get > > the > > care out of state except for a consultation. It might be worthwhile to > > contact > > IDF to help you find a specialist to help you for the problems you are > > having > > specifically. There may be someone better aware of how to deal with her > > needs on > > a consultant basis even in an out of state institution. It would take > > working > > with someone to advocate for you or having the labs etc drawn in CA and > > having > > someone consult from out of state such as at the Cleveland Clinic. Is > > there > > a Pediatrician or Immunologist that could help you get the answers you are > > seeking? > > Barbie > > Lucas with CVID, Bipolar etc > > > > > > BARBIE > > > > >________________________________ > > > From: Kookoo <nalla70@...> > > > > > >Sent: Tuesday, January 24, 2012 9:13 AM > > >Subject: Re: Insurance Question > > > > > > > > > > > > > > > > > >Not sure on all that, but I wonder how so many get their kids to even > > qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to > > anyone who knows ) I believe we make too much to qualify Makenzie for > > Medicaid (I think that is what she would get?) so we have insurance, but > > pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it > > gets very expensive, looking at my checkbook normal people would crap lol, > > > > > >Makenzie 11 > > > 22 > > > > > > > > >> > > >> > ** > > >> > > > >> > > > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, > > because > > >> > most of the time, Medicaid will cover our copays. We had to go > > >> > out-of-state (to Atlanta) for testing last year, and the Medicaid > > didn't > > >> > cover any of it. If you are going to a " border " city, the hospital may > > >> > take your out-of-state Medicaid benefits, but you would have to > > actually > > >> > ask the providers if they will take it. Sorry... > > >> > > > >> > Mindy, mom to , 9, CVID+ > > >> > > > >> > > I have a random insurance question...andra (CVID, FG Syndrome) > > is > > >> > > under > > >> > > my husband's health insurance plan, since she is also a Regional > > client > > >> > > she > > >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do > > any > > >> > > of > > >> > > you have both private insurance and state insurance. I am wondering > > if > > >> > > Medi-Cal would be more willing to finance referrals " outside of the > > >> > > system " ....I have no idea about any of this but we are desperately > > trying > > >> > > to get a referral to Cincinnati Children's. This has been dragging > > on > > >> > > for > > >> > > well over a year (maybe longer....I've lost track) now and we really > > >> > > cannot > > >> > > afford to finance the visit ourselves. Just wonder if anyone else > > has had > > >> > > experience with this. > > >> > > > > >> > > Thanks, > > >> > > > > >> > > Jeane > > >> > > Mom to andra 15 > > >> > > > > >> > > > > >> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 My son's Medicaid pays 100% of his out of state care- doctors and hospitalizations and procedures. Sue From: Barbara Jimenez <mother5590@...> Subject: Re: Re: Insurance Question " " < > Date: Tuesday, January 24, 2012, 9:21 PM  From experience and from working with National Patient Advocacy Foundation I can tell you that a Medicaid plan will not pay for out of state care. The GREAT purpose for medicare would be to pick up your deductibles and copays in Ca that your primary insurance does not pay. A provider cannot charge you beyond what your primary insurance pays if you show them your medical card. You may be able to get your primary insurance to pay if you can prove to them that the care is not available in your state but I do not think they will believe that in a state like California with the level of care available there at UCLA, Stanford and other BIG University Hospitals. Sadly with the way our system is right now the ability to get care in other states is almost impossible. It is all about saving money and so if you have the financial resources is the only way to get the care out of state except for a consultation. It might be worthwhile to contact IDF to help you find a specialist to help you for the problems you are having specifically. There may be someone better aware of how to deal with her needs on a consultant basis even in an out of state institution. It would take working with someone to advocate for you or having the labs etc drawn in CA and having someone consult from out of state such as at the Cleveland Clinic. Is there a Pediatrician or Immunologist that could help you get the answers you are seeking? Barbie Lucas with CVID, Bipolar etc  BARBIE  >________________________________ > From: Kookoo <nalla70@...> > >Sent: Tuesday, January 24, 2012 9:13 AM >Subject: Re: Insurance Question > > > > > >Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, > >Makenzie 11 > 22 > > >> >> > ** >> > >> > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, because >> > most of the time, Medicaid will cover our copays. We had to go >> > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't >> > cover any of it. If you are going to a " border " city, the hospital may >> > take your out-of-state Medicaid benefits, but you would have to actually >> > ask the providers if they will take it. Sorry... >> > >> > Mindy, mom to , 9, CVID+ >> > >> > > I have a random insurance question...andra (CVID, FG Syndrome) is >> > > under >> > > my husband's health insurance plan, since she is also a Regional client >> > > she >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any >> > > of >> > > you have both private insurance and state insurance. I am wondering if >> > > Medi-Cal would be more willing to finance referrals " outside of the >> > > system " ....I have no idea about any of this but we are desperately trying >> > > to get a referral to Cincinnati Children's. This has been dragging on >> > > for >> > > well over a year (maybe longer....I've lost track) now and we really >> > > cannot >> > > afford to finance the visit ourselves. Just wonder if anyone else has had >> > > experience with this. >> > > >> > > Thanks, >> > > >> > > Jeane >> > > Mom to andra 15 >> > > >> > > >> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 It must be some special arrangements that has been put together between the states or the specific care is not available in your state. I am glad to hear that it has been available for you. They refused to pay since I could have surgery in our state even though the level of experience was vastly different. I went to the Mayo clinic and paid out of pocket and then waited the 5 months for my Medicare to kick in so I could finally have the surgery to take the pressure off of the cord. I had letters from my doctors about how rare my injury was and how serious it was but NO WAY with multiple appeals. I think I would be in a wheelchair if I had not gone to the more experienced surgery since the surgery has had poor outcomes for many. From: sudubo@... Date: Tue, 24 Jan 2012 20:56:27 -0800 Subject: Re: Re: Insurance Question My son's Medicaid pays 100% of his out of state care- doctors and hospitalizations and procedures. Sue From: Barbara Jimenez <mother5590@...> Subject: Re: Re: Insurance Question " " < > Date: Tuesday, January 24, 2012, 9:21 PM From experience and from working with National Patient Advocacy Foundation I can tell you that a Medicaid plan will not pay for out of state care. The GREAT purpose for medicare would be to pick up your deductibles and copays in Ca that your primary insurance does not pay. A provider cannot charge you beyond what your primary insurance pays if you show them your medical card. You may be able to get your primary insurance to pay if you can prove to them that the care is not available in your state but I do not think they will believe that in a state like California with the level of care available there at UCLA, Stanford and other BIG University Hospitals. Sadly with the way our system is right now the ability to get care in other states is almost impossible. It is all about saving money and so if you have the financial resources is the only way to get the care out of state except for a consultation. It might be worthwhile to contact IDF to help you find a specialist to help you for the problems you are having specifically. There may be someone better aware of how to deal with her needs on a consultant basis even in an out of state institution. It would take working with someone to advocate for you or having the labs etc drawn in CA and having someone consult from out of state such as at the Cleveland Clinic. Is there a Pediatrician or Immunologist that could help you get the answers you are seeking? Barbie Lucas with CVID, Bipolar etc BARBIE >________________________________ > From: Kookoo <nalla70@...> > >Sent: Tuesday, January 24, 2012 9:13 AM >Subject: Re: Insurance Question > > > > > >Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, > >Makenzie 11 > 22 > > >> >> > ** >> > >> > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, because >> > most of the time, Medicaid will cover our copays. We had to go >> > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't >> > cover any of it. If you are going to a " border " city, the hospital may >> > take your out-of-state Medicaid benefits, but you would have to actually >> > ask the providers if they will take it. Sorry... >> > >> > Mindy, mom to , 9, CVID+ >> > >> > > I have a random insurance question...andra (CVID, FG Syndrome) is >> > > under >> > > my husband's health insurance plan, since she is also a Regional client >> > > she >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any >> > > of >> > > you have both private insurance and state insurance. I am wondering if >> > > Medi-Cal would be more willing to finance referrals " outside of the >> > > system " ....I have no idea about any of this but we are desperately trying >> > > to get a referral to Cincinnati Children's. This has been dragging on >> > > for >> > > well over a year (maybe longer....I've lost track) now and we really >> > > cannot >> > > afford to finance the visit ourselves. Just wonder if anyone else has had >> > > experience with this. >> > > >> > > Thanks, >> > > >> > > Jeane >> > > Mom to andra 15 >> > > >> > > >> > > Quote Link to comment Share on other sites More sharing options...
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