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CA is a dream state compared to NC and some other GOP ruled southern states like AL, GA, LA, FL - all of which are on the opposite end of the spectrum in political philosophy which is what determines the accessibility and benefits of their social programs.
Dream state? Depends on if you're giver or a taker.....
Dream for takers, but nightmare for givers.
Hi,
My children have Medicaid in North Carolina where we live. Last month we were in California and had to take 2 of the children to the Emergency Room. The hospital said they take Medicaid. I've now discovered North Carolina Medicaid doesn't cover out of state. So we've been hit with doctor and hospital bills. We've spoken to the doctor's billing office and they've reduced it by 50%. Still speaking with the hospital who have sent the highest bills and also incorrectly sent them via a collections agency, who said they shouldn't have be asked to deal with this yet because it's only been a few weeks and the hospital hadn't even billed us yet!
Any suggestions on how else we can deal with this?
What if we visit another state again and have to receive medical treatment, do we have to get some kind of travel insurance?
Many thanks
Jukes:
Contact the hospital's Patient Financial Advocate. Every hospital should have one. If the PFA can't help you, you may have no alternative but to pay the bill. The PFA works for the patients, NOT the hospital, is independent of the hospital.
Unless it is the ONLY insurance program in the state, Here is one stupid reason your medicaid is not paying: if you {or your children} are qualified for Medicaid {meaning someone should be poor, poverty level}, then you {or the children} should NOT be financially able to travel longer distances, ESPECIALLY across the country, even if someone like grandparents paid the way.
Also; almost all insurances don't want to cover ""out of network" bills, as they may have to pay more than a contracted amount like to the in-network bills. going to another state is almost always considered "out of network"...
ALso, try this {most likely won't get you anywhere, but its worth a try to see what info they can give you}: https://www.medi-cal.ca.gov/
Medi-cal is the California version of Medicaid there. MAYBE you can qualify {i doubt it -you aren't a resident of CA, but if there long enough, perhaps....they can help. perhaps you can find out what they would have paid the hospital and you cna offer them that as pay-in-full.
The third option is to FIND OUT if the hospital has a back up financial program for the poorest of customers...they may have a Patient Financial Program. Many do, it is NOT an insurance program, but will either seriously reduce or eliminate your financial obligations. Our local hospital has one that covers up to 100%, 75%, or minimally 50% discount off for family of 4's incomes -in some cases- of up to 58K{or +++} a year, or about 400% over poverty level. If they have a PFP nowadays you have to prove you have some kind of insurance first, then it will kick in for what a insurance policy won't cover. For HOSPITAL services ONLY. Again as the Hospital. You submit your financial documents and they give you a rate of discount. It would/should cover the ER room costs. {only}
Many people are NOT aware of help, programs to help cover costs incurred at medical facilities, I have been through about everything in the health care services, and have learned along the way.
Best of luck to you and yours,
P.S.: ALWAYS carry Benadryl Allergy medication with you {or the generic} it can go a long way against an allergen, and start the process to stop it from becoming more serious {may not solve the entire problems.}. Still seek medical attention, also, now, see if you can get Epi-pen auto injector {epinephrine} for allergies from their regular doctor, it will also help in case they get exposed to the allergen again.
Very interesting, thank you. Re. sending in an appeal, I spoke to the Medicaid office in Buncombe County where we live in Asheville, NC. So, do I send the appeal in to them? They didn't even ask what the ER visit was for, just said they don't cover out of state ER visits, then the lady said 'well only if a really serious car crash, if you get what I mean...". I admit that sounded kind of strange.
And yes, my son's was having a really severe reaction and everything we read on the internet said take to ER! I can even send photos in with an appeal.
Thanks!
That is because Medicaid is a federal/state coverage run by the states. Medicaid in one state has no control over another state's Medicaid.
Very interesting, thank you. Re. sending in an appeal, I spoke to the Medicaid office in Buncombe County where we live in Asheville, NC. So, do I send the appeal in to them? They didn't even ask what the ER visit was for, just said they don't cover out of state ER visits, then the lady said 'well only if a really serious car crash, if you get what I mean...". I admit that sounded kind of strange.
And yes, my son's was having a really severe reaction and everything we read on the internet said take to ER! I can even send photos in with an appeal.
Thanks!
I'm so sorry this happened to you! but you did the right thing, you took him to the ER, your son is alive, everything else can be handled. I would most definitely appeal, and send pictures. Many times the clerks in the offices just don't get it, their medical knowledge is limited. They may think all allergies are simple, non-life-threatening episodes.
Medicaid is a state-funded program. My stance in such situations---everybody has a boss. go all the way to the top. Do you have a state ombudsman? Most states have such, their job is to assist in such cases, where a citizen is having difficulty obtaining services.
Perhaps next trip carry a bottle of Benedryl! About 5 years ago, we moved into a new house, with new carpet. I was sitting barefoot on the carpet, when I noticed hives begin to form on my feet. They spread rapidly up my legs, torso, even my scalp! I also felt a tightness in my throat, numbness and tingling in my lips. I was alone at home and about to dial 911, when I stopped to consider the cost. We have insurance, but our deductibles, copays, etc are high. I found a bottle of children's benedryl in the pantry and just drank the whole thing. The reaction stopped. Obviously I was having a reaction to something in the new carpet and it was severe, but, unfortunately, here in America one must consider the cost of medical care along with the necessity.
How did your story end? I have the same issue. I have Medicaid in California, but had to go to ER in North Carolina. The ER/hospital doesn't contract with California, probably because CA doesn't pay very much. So now I am left with the bill. Still trying to find an equitable solution.
Unless you are a health provider on the state line, it doesn't make sense to become a provider for an out of state Medicaid. There are quite a number of hoops and fees to jump through. The cost to become a provider is more than you will earn. You'll have to see if California Medicaid has a provision for emergency treatment. If not, you will need to contact the hospital in North Carolina and work out a payment plan.
How did your story end? I have the same issue. I have Medicaid in California, but had to go to ER in North Carolina. The ER/hospital doesn't contract with California, probably because CA doesn't pay very much. So now I am left with the bill. Still trying to find an equitable solution.
Have you, or the NC ER, contacted this Medi-Cal unit ?
What services does Medi-Cal cover for recipients who are temporarily out of state? CCR, Title 22, Chapter 3, Article 1.3, Section 51006, allows reimbursement for medically necessary emergency services that need to be provided by an out-of-state provider to California Medicaid (Medi-Cal) recipients temporarily in another state. Note that some services require authorization. For more information, call the Out-of-State Provider Unit at (916) 636-1960.
What services does Medi-Cal cover for recipients who are temporarily out of state? CCR, Title 22, Chapter 3, Article 1.3, Section 51006, allows reimbursement for medically necessary emergency services that need to be provided by an out-of-state provider to California Medicaid (Medi-Cal) recipients temporarily in another state. Note that some services require authorization. For more information, call the Out-of-State Provider Unit at (916) 636-1960.
This never happens. The out of state provider has to jump through so many expensive hoops, it's not worth it and there's no reason for them to do this. They are better off billing the patient. It's the PATIENT'S "insurance" so the patient is responsible for getting them to pay....if they will.
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