My daughter was born with congenital heart defects. She has always been covered by our private insurance as well as medicaid because of the severity of her health condition. when going to the doctor I have always said our private insurance was primary and that medicaid should be billed secondary but recently a receptionist reacted strangely to this as though it should be the other way around. I never even considered that medicaid should be primary. I'm wondering what other people do in this situation. Can medicaid be primary? We have a lifetime maximum benefit on our private insurance and with all the surgeries and follow up care we surely will reach it someday. Would it be smarter to have medicaid be primary? Are they a pain to deal with in this situation? We have never had any problems with medicaid covering our daughter so i surely don't want to rock the boat. I'm just wondering what other parents experiences are and how you handle this.
Thanks everyone for your quick responses. You really helped clear this up for me and now I know that what we are already doing is the right way to go and we won't be making any changes.
I worked in coordination of benefits for 8 years, and doubt anything has changed. As long as you are working,and she is a minor your private health insurance is primary, medicaid is 2ndry.
I think it depends on your private insurance...you may want to call them and ask if they should be primary or secondary. It may have something to do with the size of your private insurance company (ex: how many employees are covered). I work for the state and my husband is also on medicare due to disability. My insurance company told me they were primary and medicare is secondary and I am sure it has to do with the size of the company.
Medicaid will always be secondary. Medicaid will not pay if they believe another source will pay first.
Medicaid will never be primary. They are always secondary to your other insurance. Sometimes it doesn't work the best that way but that is how it works. Good luck.
with this kind of thing, i would ask your social worker. i always just email or call my social worker for things like this. if they don't know the answer, they'll find out for you.
We were told that if you have private insurance as well as medicaid that the medicaid is always secondary. For us, our private insurance is always billed first and medicaid just picks up the copays.
Illinois has a special program that I can sign up for my son. He receives very expensive medication. This program would step in after I pay my required out of pocket expenses/co-pays. they would pay after the insurance pays their share. As part of the program, once I get within a certain range of the lifetime max, they step in to make the payments so I do not hit that. I have a friend with a child with a heart problem as well and Medicare is the secondary after her private insurance.
I live & work in Mn. Here in Mn ma is basically always the last payer- My son has ma on a programs (tefra) (working parents that have a parental fee each month based on income for kids with diabilities) I would say that the only time when ma is prime is when there is no other insurance- If your not sure call your ma worker in your county.
states may all be a little different but in iowa if the child is under 21, medicaid can be billed as primary then they go after the actual primary private insurance to collect the money back. sometimes it's easier for the medical provider in case a service isn't covered by the primary or the ease of not billing two different insurances. as long as it is covered by medicaid, it's the provider's fault if they don't get all their money - you're covered.
S. m
I agree with the other posters - Medicare or MA is always secondary to the private insurance. I have two special needs kids and they have a primary insurance and then MA because of their special needs and the costs surrounding their medical expenses. I specifically asked this question of both MA and the private carrier because my private carrier has NO lifetime max and I didn't want to lose that kind of insurance if MA was first (what if we lost the MA later - it is almost impossible to get private insurance with no cap). Don't let the clinic receptionist goof you up here :) Some are really good - some don't know what they are talking about.
Hi there, I work for a healthcare organization in Wiscsonin. Medicaid is always a 'payor of last resort' meaning that if there is any other source of payment for the claim, they need to be billed first. If they deny the claim for any reason, that denial needs to be included in the bill sent to Medicaid.
All private insurance plans, Medicare, work comp, liability insurances, etc. will need to be billed before Medicaid. The state keeps a database of what insurances you have active on file, & if they do not receive the denial or payment information from that insurance with your claim, they will deny for 'other insurance primary'. If they do not have any other insurance on file, & they are billed as primary & pay, but find out later that you did have active insurance that should have been billed, they will contact the provider of service & request their money back, or a valid denial from the primary insurance.
You are correct in stating that Medicaid should not be primary. However, a receptionist is not necessarily a biller, & 99% of the time, the staff billing the claims will set things straight. At the very least, Medicaid will deny the claim & the correct claim will bill out soon after to your primary. Good luck with your little one! T.
We have a son who has cystic fibrosis and we have private insurance and medicaid also. My understanding is that our private insurance is to be primary and then medicaid covers the rest.
Yes you are correct. Your private insurance is primary and MA is secondary. If a facility actual makes a "mistake" and bills MA and by chance MA pays for it, when the claim is reviewed, it then will be rejected and you will be billed. It is then your responsibility to go and get your money from your private insurance..... A BIG HEADACHE! Trust Me.... So you are doing correct. When you sign your renewal forms it is actually on the back of the billing agreement. You will find many times (depending on your insurance) that MA ends up only paying co-pays. By chance do you have a parental fee that you have to pay each month?
I'm pretty sure the receptionist was wrong. Your insurance is primary and the state is secondary. The only way the state would be primary is if that was the only insurance you had.
Check with your case worker to be sure, but here in Wisconsin the private insurance is always primary then Medicaid secondary.
