RE: ? about MediCal with a commercial plan

[Guest guest]

In RI if you have a commercial plan and medicaid due to low income or adoption as secondary, then the commercial insurance is primary, the medicaid picks up copays so for example if you have a $30 copay and and the commercial insurance payment is $58, then medicaid is supposed to pay the rest but they won't, stating that the payment made has already exceeded their fee schedule, so your total payment from the patient is $58 - patient not liable if you accept medicaid.Great for the patient, not so great for you. If you don't accept medicaid then you can bill the patient for the copay. for drugs if patient on both, medicaid will pay for cost of meds without copay BUT the formulary is very basic and if not on formulary it is tough to get them. not sure if all states are the same. To: From: docsharon@...Date: Mon, 22 Nov 2010 20:40:18 -0800Subject: ? about MediCal with a commercial plan

Anyone know how MediCal (or in other states, Medicaid) works if the patient also has commercial coverage?

I have a couple who just adopted 2 foster kids (very happy and long story) who will have MediCal coverage for life and I'm trying to advise them on which insurance plan to choose through their employers......for example, can you go back and forth using one then the other; will MediCal pay for presciptions that Blue Cross only pays part of? (They are trying to decide if a high deductible plan with much lower premiums would work.) Neither the health plans or MediCal phone people seem to be able to answer our questions...

If anyone thinks this is a sane system we have now, let me send you the options University of California is offering people for next year; rates went up so much they came up with all kinds of crazy plans. Even for me, who deals with this every day, it is impossible to sort out......

SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com

[Guest guest]

medicaid is  a program that states mostly run but  doso  jointly with the feds ,as  the feds contribute  significant funds, in  addition to the states' funding  It is always the payor of last resort This is the same as  what lynn says  Having a commerical insurance with medicaid as a secondary is not too common but I have seen it- again depends on you r  own states' eligibility  rules. Here medicaid will pay the copay  part off of commercial plans  if income eligible

Short answer- you have to  ask  MediCal)

 

In RI if you have a commercial plan and medicaid due to low income or adoption as secondary, then the commercial insurance is primary, the medicaid picks up copays so for example if you have a $30 copay and and the commercial insurance payment is $58, then  medicaid is supposed to pay the rest but they won't, stating that the payment made has already exceeded their fee schedule, so your total payment from the patient is $58 - patient not liable if you accept medicaid.

Great for the patient, not so great for you. If you don't accept medicaid then you can bill the patient for the copay.  for drugs if patient on both, medicaid will pay for cost of meds without copay BUT the formulary is very basic and if not on formulary it is tough to get them. 

not sure if all states are the same. To: From: docsharon@...

Date: Mon, 22 Nov 2010 20:40:18 -0800Subject: ? about MediCal with a commercial plan

 

Anyone know how MediCal (or in other states, Medicaid) works if the patient also has commercial coverage?

I have a couple who just adopted 2 foster kids (very happy and long story) who will have MediCal coverage for life and I'm trying to advise them on which insurance plan to choose through their employers......for example, can you go back and forth using one then the other; will MediCal pay for presciptions that Blue Cross only pays part of?  (They are trying to decide if a high deductible plan with much lower premiums would work.)  Neither the health plans or MediCal phone people seem to be able to answer our questions...

 

If anyone thinks this is a sane system we have now, let me send you the options University of California is offering people for next year; rates went up so much they came up with all kinds of crazy plans.  Even for me, who deals with this every day, it is impossible to sort out......

 

SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com

-- PATIENTS-please remember  that email may not be entirely secure, and that Email is part of the medical  record and is placed into your  chart ( be careful what you say!)

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[Guest guest]

I have a family like that. When I first billed their private ins I received received letter stating they believe Pt has another insurance and waiting for explanation from parents. It took a while but private finally paid. Same situation if Pt is Medicare and still working w private ins they want that letter from Pt to make private primary. Then I send off secondary claim to Medicare Sent from my iPhone

Anyone know how MediCal (or in other states, Medicaid) works if the patient also has commercial coverage?

I have a couple who just adopted 2 foster kids (very happy and long story) who will have MediCal coverage for life and I'm trying to advise them on which insurance plan to choose through their employers......for example, can you go back and forth using one then the other; will MediCal pay for presciptions that Blue Cross only pays part of? (They are trying to decide if a high deductible plan with much lower premiums would work.) Neither the health plans or MediCal phone people seem to be able to answer our questions...

If anyone thinks this is a sane system we have now, let me send you the options University of California is offering people for next year; rates went up so much they came up with all kinds of crazy plans. Even for me, who deals with this every day, it is impossible to sort out......

SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com

[Guest guest]

MediCal is always the “insurer of

last resort.” So if the kids are eligible for their employer’s

plan, that will be primary. You cannot go back and forth using one then the

other. MediCal won’t pay anything if you’ve been paid more than

their “allowable,” which might as well be $0 because they pay worse

than any other payer. If you are not a Medi-Cal provider, you will be paid

exactly $0. When we dropped Medi-Cal, we advised our patients that we would

continue to see them for a “discounted rate.” We kept about 10

patients; we see a few of them at no charge. One of them actually became eligible

for Medicare and now we can her MA plan.

Good luck to them…

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of Sharon McCoy

Sent: Monday, November 22, 2010

8:40 PM

To:

Subject: ?

about MediCal with a commercial plan

Anyone know how MediCal (or in other states, Medicaid) works if

the patient also has commercial coverage?

I have a couple who just adopted 2 foster kids (very happy and long

story) who will have MediCal coverage for life and I'm trying to advise them on

which insurance plan to choose through their employers......for example, can

you go back and forth using one then the other; will MediCal pay for

presciptions that Blue Cross only pays part of? (They are trying to

decide if a high deductible plan with much lower premiums would work.)

Neither the health plans or MediCal phone people seem to be able to answer our

questions...

If anyone thinks this is a sane system we have now, let me send you the

options University

of California is offering

people for next year; rates went up so much they came up with all kinds of

crazy plans. Even for me, who deals with this every day, it is impossible

to sort out......

Sharon

Sharon McCoy

MD

Renaissance Family Medicine

10 McClintock Court;

Irvine, CA

92617

PH: (949)387-5504 Fax: (949)281-2197 Toll free

phone/fax:

www.SharonMD.com

[Guest guest]

Thanks for everyone's experiences.  To clarify, this family is a scholarship patient in my practice and I'm not worried about getting paid, but trying to help them sort out what would work best for them for stuff outside my practice.  One of the moms doesn't want to add the kids to their insurance even though they are eligible now (would cost about $100/month for the cheapest plan) because MediCal covers (some) meds and such completely , the other really wants the ease of using the insurance.

 

Anyone in CA know if they can still get the " free' meds from MediCal if they sign up with Anthem?  What about radiology, labs, and consults?  I guess all of those probably have to be referred from a participating provider (which I am not)?  The Anthem plan they will most likely sign up for is high deductible so this does make a difference.

 

If only the people who answer the phone at these places could answer such complicated questions!  But there is a lot of new territoriyt being charted with health care payment these days.

 

Sharon

[Guest guest]

Sharon,

We have never had a patient tell us that

their labs, etc weren’t covered by Medi-Cal, even though Steve is

ordering them. I think as long as the lab or facility takes Medi-Cal that it

gets covered. The local pharmacies may be able to better answer the question

about Medi-Cal covering meds. I would think that if they choose a high

deductible plan, then the plan would initially pay $0 and Medi-Cal would pay

what they would normally pay. So, for example, if you were a Medi-Cal provider

and billed a 99213 to Anthem, which said that $65 was the allowable amount and subject

to deductible, that would go to Medi-Cal, and they would pay the $19 (or

whatever it is) that they would normally pay. I would think the same would

apply to medications.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of Sharon McCoy

Sent: Tuesday, November 23, 2010

3:06 PM

To:

Subject: Re:

? about MediCal with a commercial plan

Thanks for everyone's experiences. To clarify, this family is a

scholarship patient in my practice and I'm not worried about getting paid, but

trying to help them sort out what would work best for them for stuff outside my

practice. One of the moms doesn't want to add the kids to their insurance

even though they are eligible now (would cost about $100/month for the cheapest

plan) because MediCal covers (some) meds and such completely , the

other really wants the ease of using the insurance.

Anyone in CA know if they can still get the " free' meds from

MediCal if they sign up with Anthem? What about radiology, labs, and

consults? I guess all of those probably have to be referred from a

participating provider (which I am not)? The Anthem plan they will most

likely sign up for is high deductible so this does make a difference.

If only the people who answer the phone at these places could answer

such complicated questions! But there is a lot of new territoriyt being

charted with health care payment these days.

Sharon