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Health insurance situation (America; Medicaid)

OboroOboro __BANNED USERS regular
edited October 2008 in Help / Advice Forum
On October 17th, I have a formerly-arranged appointment with a neurologist. This is scheduled to be taken care of via insurance I am technically covered by -- my father's grandfathered plan with Blue Cross Blue Shield, that he got when he retired, covers me until I turn 21 (December 30th of this year). The deductible has been met for this year, and the copays are easy to meet.

This insurance, however, uses two separate benefits pools ... one for traditional medical, and one for mental health. The mental health benefits for this year are completely exhausted, after two inpatient hospitalizations and some other care through July. I have, accordingly, been untreated since July and being untreated tends to make it very hard for me to remain functional for any period of time. It only takes a day or two of delusion-fueled screw-ups to lose a job, and I am sometimes a danger to myself or others as a result of my condition. Because of this, I have an imperative to seek mental health care.

On October 13th, I have a meeting with social services to assess my eligibility for Medicaid. On the application for benefits, I list that I am uninsured, which is technically true ... while also being technically untrue. I've been told that not having benefits qualifies one as 'uninsured,' at least for the duration, and I've heard this from multiple people so I believe it.

I require care, and am uninsured. I also require care, and am insured. One of the avenues requires Medicaid, the other could be handled with my private insurance, but would probably constitute fraud if nothing changed as presently described.

On October 13th, I can amend my application to state that I technically sort of half kind of have insurance, and maybe lose the Medicaid benefits I may receive. I may also not change what I said, cancel my appointment with the neurologist, and then go through the government channels to receive that same care (for an unrelated condition, not related to the mental health) via the Medicaid benefits ... if that's even plausible. I don't know a lot about Medicaid. I don't know if this is plausible.

I already found the mental health care that would be arranged through the Medicaid and that's perfect. If I get the Medicaid, I get that. However, I'm not sure if my getting it would constitute fraud, and I'm not sure if I would be able to get it and continue exercising my physical health insurance benefits through Blue Cross Blue Shield until December 30th, without also committing fraud.

Should I declare my technical coverage with Blue Cross Blue Shield (which was also the coverage that provided for my previous hospitalizations this year, instrumental in establishing my conditions that I require the Medicaid for), or should I continue with not declaring it?

Should I, assuming I do receive Medicaid benefits, then attempt to use those benefits for my physical condition additionally, or is that sort of coverage insufficient or otherwise constrained in such a way as to make it unworkable? Am I liable if I use my Blue Cross Blue Shield coverage, as scheduled, to continue care?

The Application for Benefits very clearly states that willfully providing 'false' or 'misleading' information is a felony. At the same time, I'm hesitant to speak frankly to the person doing the interview because I don't want to jeopardize the acquisition of coverage which I do technically need.

Oboro on


  • ArdorArdor Registered User regular
    edited October 2008
    You could always try calling their customer service line and ask them about gaining coverage when your current plan can't cover you or you want to change to see what they suggest. If they don't ask for any information from you, you could probably ask them that question.

    I thought I remember you saying you were attending school, if this is the case, you could try talking to the benefits folks there to see if they can help you. Otherwise, have you tried takling to Blue Cross Blue Shield to see what they recommend? They may have some options for you besides "Buy better coverage from us!".

    It's probably not unreasonable to say you are uninsured since as of ~2 months from now, you won't be anyways. However, I'd still try to get some information from one of the two places involved here.

    Ardor on
  • Richard_DastardlyRichard_Dastardly Registered User regular
    edited October 2008
    It's possible for you two have medicaid as your secondary insurance, to pick up any left-over costs from your primary insurance. I don't understand how you can be "sort-of" insured. If you're covered under a health plan, no matter how terrible that coverage is, you should definately have listed yourself as insured.

    Also, have you talked to the hospital/neurologist/health system you plan on going to? Some have a sort of in-house charity that helps cover medical costs. But, I think many of those are for people who are completely uninsured and, for whatever reason, don't qualify for medicaid.

    Richard_Dastardly on
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