Search results

  1. C

    Dr had to drop me because I might lose my Medicaid if I continue to see him. Weird situation

    @wnnipooh Call your insurer - your Medicaid carrier. They'll be able to advise.
  2. C

    Should I quit my job to get the medication I need because my insurance through my employer is denying and delaying a med that my Medicaid approved?

    @jadelynn Wow - of all the things you could advise, you provided literally the worst sort of advice.
  3. C

    Dr had to drop me because I might lose my Medicaid if I continue to see him. Weird situation

    @wnnipooh Your Medicaid benefits likely have a Mental and Behavioral Health network with a provider search. Since they're presumably your MCO, their network is likely larger than you think - but finding a new provider, specifically a new psychiatrist and therapist can be extremely stressful. If...
  4. C

    Should I quit my job to get the medication I need because my insurance through my employer is denying and delaying a med that my Medicaid approved?

    @thavener May not participate with their state's Medicaid program - Medicaid recipients must receive their medications through contracted pharmacies.
  5. C

    Optum Is the worst (out of network, no NPI)

    @jamiee As long as they've provided a TIN, UHG can run a transaction for them - they'll essentially create a dummy NPI. Edit: Note, you're likely going to have to pay out-of-pocket and then you'll get reimbursed. Since it sounds like the provider is OON, you may not get reimbursed the full...
  6. C

    Should I quit my job to get the medication I need because my insurance through my employer is denying and delaying a med that my Medicaid approved?

    @mattjorgdbb This is probably the best move. Complaint and appeal workers know the systems and can get issues like these resolved. Agent who works in Regulatory Compliance and has previously worked on escalation and resolution teams.
  7. C

    Optum Is the worst (out of network, no NPI)

    @jamiee Uh - WHAT?! Your provider is actively violating CMS guidance. (Edit: Note - this is assuming that they do ANY electronic records or billing transmissions - if they don't deal with insurance or e-billing/invoicing at all, it's possible that they don't - but they'd be in the EXTREME...
  8. C

    Should I quit my job to get the medication I need because my insurance through my employer is denying and delaying a med that my Medicaid approved?

    @ashe It isn't. I specialize in Medicare and Medicaid regulatory compliance - if you're enrolled on these programs, you may not use a prescription discount card. The commercial plan is mandated to do the crossover to the Medicaid plan for any denied RX fills. They can't use prescription...
  9. C

    Should I quit my job to get the medication I need because my insurance through my employer is denying and delaying a med that my Medicaid approved?

    @ashe Not eligible as they're a Medicaid recipient. You can't use manufacturer cost-reduction cards if you're on any sort of government health policy.
  10. C

    Delivering at hospital that’s out-of-network?

    @rozenliefde Thanks for the clarification. I mainly deal with Medicaid and Medicare plans so commercial policies and benefits aren't my strong suit.
  11. C

    Delivering at hospital that’s out-of-network?

    @rozenliefde Are you sure this is accurate? The OP states that they're on a family group plan and generally on most policies I've seen, M&B services do not apply to dependents but only the primary and secondary on the account. To my reading, this likely would not qualify for the NSA as it...
  12. C

    Us “poors” can’t get a real doctor anymore and finding a NP isn’t easy either.

    @teelea68 Contact Cigna and request a Member Advocate, Health Advocate, etc. If it's an available benefit, they can call on your behalf to find an INN provider. Otherwise, call Cigna and ask for the details of their network adequacy requirement is for your plan type. They have to have a...
Back
Top