Does medicaid pay towards primary insurance deductible?? Too good to be true? - Mothering Forums

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#1 of 6 Old 08-17-2011, 06:40 AM - Thread Starter
 
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OK, don't know where to start b/c this is so dang confusing to me, but here goes...

 

While I was pregnant I had medicaid (BadgerCare, since we are in WI) but I also had Anthem BCBS. I applied for BadgerCare b/c my policy with Anthem did not cover any maternity related services. I was dropped from BadgerCare at the end of June, 60 days after I had my baby. During my pregnancy I also injured my knee (completely tore my acl).

 

So it looks as though all the expenses related to my knee have been counting towards my deductible because on my latest statement from Anthem it says I have $3590 accumulated towards my $5000 deductible/maximum out of pocket. I never saw any bill for anything related to my knee. I had several visits to dr.s, surgeons, PT and I always checked that they took BadgerCare, so those bills must have gotten paid by BadgerCare.

 

I would like to take advantage of the fact I am so close to my deductible and have knee surgery this year and would only have to pay $1400 for it! But this all seems to good to be true. Does Anthem care that BadgerCare really paid the $3590 worth of expenses and it didn't come out of my pocket?

 

I have tried to email Anthem - I asked them if having secondary insurance during the course of this year would have any effect on my policy - but got some generic answer about how the policy is limited to terms and conditions in the policy contract. Emailing Anthem is better for me with 2 small children. I will call them as a last resort, but I'm afraid I may go off on them b/c I think health insurance companies are the biggest sham out there...

 

My mom thinks I need to spell it out to them, tell them right up front I had BadgerCare & that they paid all of the bills and this money towards my deductible/out of pocket maximum did not come from me. I say that nowhere does it say on my statements "money that you have paid towards you deductible/OOP max." KWIM?

 

Anyway, I'm rambling. Anyone been in a similar situation or know more about this?

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#2 of 6 Old 08-17-2011, 07:17 AM
 
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Where I am you would be correct.  It sounds like Anthem was billed first and then BadgerCare picked up the rest.  State plan often do this because it's cheaper for them to just pay your co-pays then to pay 100%.

 

EX my parents are Medicare eligible.  My dad is still working and has private insurance through his work.  He had his knee replaced in June.  Cigna was billed first and then Medicare took care of all but 20% of what was left.  So I think they would up paying about $180 for a full knee replacement with 4 day hospital stay, surgeon fees etc.

 

You were smart to make sure everyone was a participating provider.

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#3 of 6 Old 08-17-2011, 07:42 AM
 
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Hmmm.... I looked up my son's account and it looks like this is what has happened with his too. He did have Medicaid. Then my dh and I got married January 1st and we put my son on my dh's insurance (United Healthcare). Medicaid said that we could keep it as a secondary insurance and they would pay for some co-pays, etc. They ended up not paying for much except the co-pay on March's therapy (my ds is in weekly therapy- he has sn). They didn't pay January, February, April, May, June or July for some reason eyesroll.gif But, what they did pay did go towards my son's deductible shrug.gif


Steph, DH Jason (1-1-11), DS Owen (10-3-03) and DS Kai (10-13-11)

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#4 of 6 Old 08-17-2011, 10:04 AM
 
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I had BCBS and Medicaid when pregnant too.  Blue Cross was billed as the primary, and my benefits statements simply showed any part that wasn't paid by them as part of the deductible.  They didn't care who paid the rest.  It worked out great for me!


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#5 of 6 Old 08-17-2011, 10:22 AM
 
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So, this thread prompted me to look into this even more. LOL! My dh got hurt playing soccer earlier this year. He ended up hurting his shoulder pretty bad. It required surgery and physical therapy (he's still going twice a week to that). Our insurance pays for whatever they will, but then he has another insurance through the place he played soccer at that covers the rest (so we pay nothing out of pocket for any of this). BUT, what the soccer insurance company has been paying has been going towards our "out of pocket maximum", even though we aren't paying for it out of pocket! I didn't realize this until now! So we've actually almost hit our out of pocket maximum for the year. After I pay off my OB we'll have hit it (actually, we might hit it before then because of my ds's weekly therapy).


Steph, DH Jason (1-1-11), DS Owen (10-3-03) and DS Kai (10-13-11)

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#6 of 6 Old 08-17-2011, 12:41 PM - Thread Starter
 
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Wow. I can't believe that this is actually working out for me. I would have never been able to pay $5000 towards my deductible for my Anthem plan, but it seems like BadgerCare did it for me. Sweet! Surgery is scheduled!

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