Medicaid Approves Coverage Providers Then Refuse to Accept
Individuals relying on Medicaid face significant hurdles in accessing essential healthcare services. Approved coverage often proves unusable due to provider discrepancies and a lack of acceptance, leading to frustration and financial strain. This highlights a systemic issue of inaccurate provider networks and a disconnect between promised coverage and actual service availability.
SOURCES (60)
“I am a business owner, I take 50k myself w2, and my PARTNER takes 75k, we have 401k.and IRA. We both fill. Lately my wife health is not well, last year just her insurance was 12000 a year then another 10k on medical bills. This…”
“I work at a public school. Medi-cal is just the California name for Medicaid. You will not see an increase, it will cost you nothing but will benefit your school immensely, which in turn will benefit your child.”
“https://cybhi.chhs.ca.gov Schools are now allowed to bill MediCal for behavioral health and wellness services. I am a former School Counselor and was always employed in public schools with public school funding. The recommended ratio for School Counselor is 1:250 students, which is very rare. Also, many rural schools fail to have a School Counselor on site at all. Imagine being the only mental health professional on a campus of 500+ hormonal teenagers!? How effective and impactful could one pers”
Do you have a source OP? Because for ACA this does not make any sense.
“My workplace doesnt have a portal to verify a patients medicare. I was looking into creating my own noridian account however they need a PTAN on top of NPI. Is there any other work around calling in? new to dc planning, also pls drop any tips you have for a beginner. 0 dc pressure from manager but my list is getting long submitted by /u/cryingpimp [link] [comments]”
“If you expect you’ll need to use insurance, probably a marketplace plan. Or Medicaid since it goes by monthly income (if OP is in or moving to a state that did the Medicaid expansion and if OP would have low/zero income for those two months)”
“Akron General is part of CCF. So is Union. And Dover. And Mercy Canton.....so yeah they have options down there too. They also have an EHP Plus plan that allows you to see other doctors at other hospital systems (with a few caveats).”
“So in order to keep your Medicaid health benefits, you have to work at least 80 hours in a month. How are people supposed to meet the requirement, when companies aren't hiring. Oh, this is just the USA, because we have the shittiest system in the world. submitted by /u/mechanicalhorizon [link] [comments]”
“As a preemie, your baby should qualify for Medicaid. Very state dependent. In mine it's only automatic if the preemie is hospitalized for 30 or more consecutive days.”
“I spent the last 8 months getting a medication covered. It’s not technically FDA approved for my wife’s full condition but it is approved for one of her symptoms. We had to go through 9 appeals including escalating to the state department and it needed multiple of her doctors to get the appeal to go through. I’m looking for another job, but we really need this medication and it’s over $200k a year to pay for it out of pocket. When is the right time to check for coverage and how do I ensure that”
“Trying to figure out whether I should manipulate my MAGI to qualify for about $700 in monthly subsidies ( income would be just under the 400% cutoff) or should I manage my income to take the subsidies. I will manage MAGI by selling stock to live on using specific lot ID and mainly foregoing Roth conversions until MAGI management is not feasible, likely when SS kicks in. Is there a good tool to help make a decision? submitted by /u/YnotLiveitUP [link] [comments]”
“If this is an ACA plan (Covered California), then MFJ nukes any premium Tax Credit. Edit to add: at 75k +30k you are over 4x the Federal Poverty level anyway. And you have to count the income of everyone in your household. So you would have to pay full freight regardless.”
Can you see if you can get paid with thier insurance as a caregiver?
“thank you for your reply, i really appreciate it. it says my out of pocket maximum is 10,900 for a married couple, how is this different from the “deductible” which is $2000 for the both of us”
“The thing is everything ive read about disability is so limiting, as a 20 year old i want to be working :/”
“I was recently terminated from a good job (a story for another day). I have multiple health conditions and have already reached my Out of Pocket Maximum for the year (this is typical as I get a yearly MRI among other things). If I pay for COBRA, my prescriptions, my visits to my therapist, and anything else that happens is "free" until the plan resets. I just have to give 30% of my unemployment checks away to achieve this. I am lucky, very lucky, to be getting a good amount in unemploy”
“My husband and I are looking for insurance as a couple who will be making $3,400 combined a month once I accept a job offer. He has T1D and has been on Medicaid his whole life. He has a pump and his boxes of supplies that come monthly are $10,000 a box. He gets 3 100ml vials of insulin a month as well. He has to have an Endocrinologist appointment every six months to keep his insulin prescriptions renewed. None of this is negotiable, it’s stuff he needs to live. We’re looking for an affordable m”
“yes, home health care is much more expansive and deals with insurance and Medicare a bunch.”
“To those who are taking medical insurances as part of the acceptances, what were your reasons to start with and what were the things you wished you knew ahead? Currently in my PPO practice, I'm placing implants, grafts, cyst removal, sleep apnea referral etc, many of which can come under medical. Hence thinking about joining a few. The office manager is eager to learn how to do it and we both know there will be a learning curve, lot of rejections in the beginning till we figure out our mista”
“Hey everybody, I really appreciate you taking the time to read this. I'm pretty new to Reddit so hopefully this belongs here. I have been working at a large insurance provider for the last decade. I have had 7 different positions (they all were in claims, sales, and services) front line call center high volume, high stress, metrics driven stuff. I didn't really want to pursue leadership as some things I would have to coach reps to didn't really seem realistic/right (unattainable goal”
“I find 24% as a mean seems so low. Most people over 55 have something going on and having deal with COBRA (a joke), is just not on the cards for most due to cost.”
“Somehow state insurance no longer sees me as medically frail and then i got a letter saying I'm gonna lose my insurance end of this month. Not sure what to do cause i take heart and thyroid meds. I can live technically without the others but i was also just freshly told i have narcolepsy. Lost my job recent too. Im angry to say the least. submitted by /u/Maximum_Tangelo2269 [link] [comments]”
“The non-SSI disabled child would likely qualify for Medicaid based on income. (Medicare is seniors.) The big issue is if they don't want to use Medicaid. I don't believe the non-disability is that big of an issue considering as long as there's enough money for supporting them. The SSI disability brings ~$1k/mo and that's reduced by roughly a third if there's housing assistance. The bigger deal is getting into things like day programs, housing programs, etc. If they can live i”
“Same conclusion. Taking a step further if you are healthy in a high cost ACA state then no ACA plan and self-pay is a better deal than the Bronze ACA plan. We are banking $30k/year post-tax by not having an ACA plan for our family of six. Tail risk bothers me, but 3 years and $90k saved already so that’s a decent cushion and it gets better every year. Plus I don’t worry about in network or out of network or any of that stuff.”
“That would be the world we are living in. There are no insurance companies catering to people who can afford to spend $170K/year on insurance premiums. Most people can only afford $5K to maybe $30K. At the high end of that range, most healthy people choose to go without insurance, and the remaining people are sick. Insurance companies need a large number of enrollees, most of whom are healthy. If that's not the case they either drop out of the individual market, or they have very narrow prov”
“After looking into this, we’ve decided the best way is to just travel abroad for healthcare. I personally travel to South Korea twice a year and get most of my non emergency medical needs taken care of there. It’s efficient and paying cash there is equivalent to co pay in the U.S. 🥲 then I bring the necessary results back to my GP in the states for ongoing care”
“Medicaid is not means tested (not based on Assets, Food Stamps/SNAP are). When your Monthly Income (Not Annual) drops to zero, you are now eligible for Medicaid - starting the MBA and leaving your old job is a valid 'change of life status'. Medicaid is the best insurance ever - the closest thing we have to national healthcare. No arguing over bills via endless AI automated menus. Basically everything is covered and hospitals love dealing with them - the gov't always pays. Had a big b”
“Maybe true. But shouldnt we try to reduce healthcare costs, not raise them? I thought reddit was all about low cost universal healthcare. Or it is rules for thee, but not for me...”
“I understand what people are saying that "you are fatfire, you can afford it", but these expenses are skyrocketing. As a Canadian/American I'm even thinking of moving back to Canada, though the care there isn't much better or even accessible (there is a limited private option there too). Thought about starting a consulting LLC with friends (WA state the LLC has to have at least one non relative). The fact that this is a concern for even this group is telling.”
“Definitely inferior to our top tier employer plan that we had before. Far fewer doctors were in network and the coverage is only in state except for emergencies. But I'm not sure how it compares to the plans that you can purchase as a small business. (Top tier employer plans are typically self insured by the employer, and different than a small business plan.)”
“I think access to UCSF via PPO might be the closest. Currently I’m on Kaiser and having a shockingly bad experience.”
“All medical enterprises accept cash. That is how they accept payments from their international customers. Go onto any hospital / medical groups payment part of their website and you will see there is an option to pay your bill. Negotiation is a separate issue, but you can definitely clear any hospital liability by paying cash.”
“Did you find anything that can be closest approximation to your FAANG-like PPO ? If so, what was it and what cost (in the Bay Area) ?”
“Yes, it's also very clear WHY the system is like that for nearly 100% of the population (rounding off 99.999 % to 100 %). And the only way to change it is with our clear-headed voting in every election.”
“Glad to hear that. I started exploring mine in WA and I am not super confident in them for a family with small children, but perhaps I just need to learn to let go.”
“A world where there aren'tindividual policies offered outside the ACA marketplace and a where most providers do not accept ACA plans.”
“This is what I did too. I figure I’m paying $20k/yr for catastrophic coverage, and I pretty much pay cash for everything else. Glad I can. Most others can’t.”
“My family friend is an immigrant to the U.S. who arrived over 15 years ago, and has spent the subsequent years living with her extended family. She is practically my grandmother and helped take care of in the past. As the years have gone by, her health issues have progressed, and Medicaid has not been sufficient for her. Unfortunately, her current income is nearly $0 and she doesn't count as an insurance claimant for the household she lives with, so access to insurance that way is null. I am”
itll cost about one trip to hawaii business class for the family per year
“In CA it's 18 months for any self-funded health plan which is basically what any reasonably sized employer will have”
“Curious about this too. We live in NY (outside the city). Health insurance is truly one of the biggest factors weighing on early retirement vs not.”
“I work part-time at a local hospital in a non-clinical support role. As such, due to my income, my family of three is on the state’s Medicaid expansion. My wife is finishing her education to get a job (maybe even at the same hospital) hospital drawing blood. If we are both working part time, we will make several thousand dollar too much to continue to qualify for the Medicaid expansion. Paying for insurance through my employer is $200 per pay period for full-time employees or $500 per pay period”
“That directly maps to my dilemma, as I use Stanford for a bunch of services, and some are pretty advanced. Chronic conditions.”
“This is the only way we could make it work in our planning as well. Staying in the US is not an option until 65 years of age, for health insurance reasons.”
“Kind of freaking out and not sure what to do. I’ve been on Medicaid for years, with my kids. I got re-married a couple years ago, but we were off and on. I claimed my home/income alongside my ex and kids, because that’s where I have most often been. Things were volatile in the past with my now husband so often I stayed with my kids and ex (just friends/family situation). Yes it’s weird, but we made due with what we could. My husband got treatment and we now live together, all good. He claimed me”