Medicaid insurance logistical nightmare

Medicaid insurance logistical nightmare

imageTwo weeks ago I called my doctor to request a referral for an orthopedic. For over a month now I’ve been having a problem with my shoulder. It’s a very strange,  I don’t know what I could’ve done to it. It mostly doesn’t hurt during the day unless it’s in a specific position. However every night I go to sleep it throbs and wakes me up because it’s killing me. I can count on my hands how many times I slept through the night in the past 40 days.  Finally yesterday I was going to see the orthopedist.  I get there and they asked me for the referral. I totally forgot about the referral. So I decide to call my doctors office for them to fax a copy. Can you say OMG CAN OF WORMS?

I was informed by my doctors office that their screen for my insurance company says my insurance is been canceled as of June 30. Mind you, I just had authorization done on two different medicines within the last two weeks. IMPOSSIBLE I say!!!!  The lovely lady tells me,it’s what it says, I can’t get a return authorization through and you need to speak to your insurance company. So knowing now I can’t see the orthopedist, I take my tired body home to what I know is going to be a long and frustrating afternoon.

My first phone call was to the insurance company. I spoke to a very uncompassionate person who said your insurance has been canceled since June 30th. I tried to ask her how, what, when, why question, since as I said I just obtained authorizations for medicine within the last few weeks, to which I was told you never had insurance with us since then so you couldn’t have received authorization.  I’m still amazed how calm I was through all of this because literally, in my hands, when I was having this conversation, was the authorization letters for the medicine. She told me I had to call my Medicaid case manager because it was recertification errors.

Second call, Medicaid case manager.  I did Medicaid for 13 years in my job so I know all about recertifications . I know my recertification is in February so I knew that could be the reason. I must’ve been a luckiest human being because my case manager answered. She told me what I really expected to hear, I’m not up for a certification, all my health screens are correct and I’m supposed to be covered by hip emblem health insurance. Like I said I know the Medicaid system well so I knew what to expect with this call.  I got no where.

Third and fourth calls were to the NY Medicaid Choice program.  These of the people that are supposed to help you choose a plan or if you have a problem with your plan. I was talking to one person who had a connect me to the other person but finally I was told that the reason I was getting dropped from my insurance was because of other insurance. My other insurance which was dropped after I left my job son disability. This is something that had to be proved as part of my original application. However I couldn’t find the letter anywhere.

Fifth phone call to my old insurance.  Even though I sent this form in one other time, I knew Medicaid would request for me to send it again. They don’t like to look anything up. Since I couldn’t find the letter, I called to get another copy of the termination letter. Luckily this was the easiest phone call I made. They faxed it right over to me. This time I made sure to keep a copy

Sixth call I needed to reach my case manager at Medicaid again. It took me 3 hours of trying her before she finally picked up the phone. I explained what I was told about the other insurance. I verified she received the fax I sent her on the proof that the other insurance was indeed terminated. She was going to get it to the appropriate department and call me back when things were updated.

Now here are all the problems still after 5 hours of calls yesterday:

  • it’s out of my hands if they will fix it timley
  •  I’m not sure that the problem is the insurance because I had two different reasons for the dropped insurance
  • i still haven’t received anything from the insurance company why I was dropped
  • this is a system that information in one screen can cause problems all over
  • there is no one person to talk to
  • im still uninsured as of today
  • ive seen doctors since July 1, 2016 who have billed already and been paid
  • this is a mess
  • i understand the system and this is a mess
  • my arm is still hurting and I can’t see a doctor now or make another appointment until this is cleared up
  • This affects not only my doctors but my prescriptions as well
  • i don’t know what to do now.

I’m lucky in the fact I know how the system works and unlucky with the same knowledge. The reason I’m skeptical over all of this is because I shouldn’t have been dropped by the Insurance if they thought I had OTHER insurance, it should have been moved down to the secondary insurance spot. They should deny as primary payer not uninsure me.  I’m from the medical billing world. This is why I’m very concerned. It’s good to have friends from my past job who can send me my Medicaid screens so I can see and read for myself.  Regardless this was a gigantic UGH!!!!!!! MOMENT.


4 thoughts on “Medicaid insurance logistical nightmare

  1. I was covered by my husband’s employers group health insurance. In January 2015 the insurance company learned I was disabled. How they learned this is still unclear. Since the company my husband works for has less than 100 employees the insurance company has the legal authority to dtop me and force me in to Medicare. The problem was similar to yours in that I was never notified of the change and not until I starting recieving medical bills did I become aware of the change in coverage which was June, 5 months later. During this period, the insurance company also continued to accept payment for 100% coverage with no reimbursement to me at a later date. I had to request multiple times for a letter from them stating they had dropped me. The problem as I see it, is with insurance coverage overall for the disabled. Our needs should be reviewed on a case by case basis. Lumping us in w seniors in Medicare whose needs are different from someone with a progressive disease only is set up to benefit the insurance companies not those who truly need medical assistance.

    1. It’s a very messed up system and I agree it should be separate for seniors and the disabled. I remember your story. Another nightmare

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