medicaid while on insurance??

[kookoo]

What is the name of your state? TX


I heard this and it made no sense to me, hope someone can clarify, its a friend.

When the mother and father split up they had one daughter. The court ordered him to pay child support and also reimburse the mother for health insurance she had on the child through her place of employment. The mother has now become pregnant with her second child by another man and has now qualified for medicaid. She told the father recently that she wouldnt give the insurance info or his daughters medicaid card until the courts said she had to. I dont understand how she can get medicaid on a child that is fully coverd by insurance that her father pays for. Isnt this fraud? I am sure she now qualifies for medicaid because of being a "single" mother now pregnant with a second child and based on her income, but how is it fair that she gets to take the child to doctors visits for free and get the medications for free now and not have told the father? It is in the papers that the mother is to split with the father all the co-pays and medication expenses when the child goes to the doctor. He has the right to take her in the papers if he needs to, but if he takes her he has to pay the money, so it looks like the mom is trying to be sneaky for her sake and doesnt want to have to pay for anything. She keeps the insurance at her job because the papers order it, and the fathers money basically goes to just keep it there. Is this medicaid abuse? shoud medicaid be notified that the older child is fully covered by insurance provided by the mothers work and paid for by the father?

 

[kookoo]

And just to add. I know it would seem like the mother would sort of be doing the father a favor by getting her on medicaid, but she wont give him any of the medications she gets (she was on medicaid in the past and then got denied because she got a raise.) and she never tells him what she is sick with or who the doctor is. Plus she sometimes wont take her at all until she has to go to the emergency room. It would be nice if he could take her when the mother refuses to just to spite him. Its a strange situation.

 

[brisgirl825]

It is possible that medicaid is a secondary insurance. It happens all the time and is not fraud.

 

[MrsK]

When my husband went through this, he was told this:

He carries pri**** insurance on his child. The mother (also has 2 kids with 2 dads, single, not working, etc) was REQUIRED to notify Medicaid. Medicaid pays the co-pays and remainder of what my husbands insurance doesnt cover. His daughter's mother is required to pay any bills leftover. She was also required to hand over a copy of the Medicaid card.

You may call Medicaid & see if she notified them of the pri**** insurance for the child b/c if she did not, Medicaid may drop her for lying (they ask when you sign up if you have any other insurance). You could also go to court & try to have it ordered that she give the dad a copy of the card for his own use when he has the child & since Medicaid SHOULD pay all copays & bills after pri**** insurance picks up, the dad shouldnt be paying any bills, as there would be none.

 

[VA_Mom]

The mother (also has 2 kids with 2 dads, single, not working, etc) was REQUIRED to notify Medicaid.

Sometimes people throw in the not working part to make it seem like the mother is a poor parent. The reality of the fact is that daycare sometimes supercedes the CP's income. I used to not understand that until I was faced with that same situation but I DO work. Unfortunately, I am in the red each week with daycare costs. So I can see why some women have made a difficult choice of recieving child support and sometimes even working out of their home to be able to save on daycare and for additional income while not reporting it.

You may call Medicaid & see if she notified them of the pri**** insurance for the child b/c if she did not, Medicaid may drop her for lying (they ask when you sign up if you have any other insurance).

Then that means mom and unborn child are not covered. Possibly letting the CP that you plan to call Medicaid to report the private insurance for this child and ask if the Medicaid being used as secondary or pri**** insurance. Most likely she will go ahead and confess because she will want the pregnancy covered.

 

[MrsK]

Sometimes people throw in the not working part to make it seem like the mother is a poor parent.

Actually she wasnt working b/c- and I quote- "I dont like to work." This is the line she gave us for over 2 years. But, she says she got a new job now b/c she cant afford to support my husband's child & her new illegitimate child on my husband's child support (nor should she legally be able to) b/c the new kid's dad isnt paying c/s yet. We think its good for her, esp b/c her support order is less than a year old, and she cant ask the court to get 1/2 of daycare for us. So she has to pay the 40% of daycare that child care assistance is not covering for EACH kid.

Then that means mom and unborn child are not covered. Possibly letting the CP that you plan to call Medicaid to report the private insurance for this child and ask if the Medicaid being used as secondary or pri**** insurance. Most likely she will go ahead and confess because she will want the pregnancy covered.

It would not be the father's problem if the mother was dropped for lying. Medicaid makes their expectations VERY clear & its really not fair that people abuse the system when there are people who need it & cant get it.

My husband had a problem like that with his child's mom. She did not tell them we no longer had pri**** insurance & so Medicaid would not pay any bills until the pri**** insurance would pay. Meanwhile, my stepdaughter needed special shoes for a problem with her leg. For 4-6 months she couldnt get the shoes b/c her mother did not follow Medicaids rules. Her leg got worse. She FINALLY got the mess straightened out. We have pri**** insurance on her again & we're sending a copy of the car along with a letter giving her 30 days to inform Medicaid of her new pri**** insurance or we will call, which may lead to her being dropped from Medicaid. If that happens, so be it. She still has pri**** insurance but the mother would be responsible for all uncovered medical bills, which Medicaid currently pays (all copays & bills after insurance).

 

[ceara19]

You can report her to Medicaid, however, if she has had the insurance this whole time, the state will already know. In Texas, when applying for medicaid the state checks the applicant's name and social security # against the private insurance database to see if they are covered by any other policy. If Dad needs to bring the child to the Dr., he just needs to let them know that the child is on medicaid when they arrive. Most Dr.'s offices, hospitals and pharmacies can do a verification in less than a minute.

 

[kookoo]

Ok this is where I am confused. She has a $163 outstanding balance at her child's doctor. If what MrsK says is true, then shouldnt medicaid have already paid this? The mother usually says "oops" and says she has just forgotten to pay the balance. Nothing has ever been mentioned about medicaid picking up the tab for what the pri**** hasnt covered. So, let me put all this together. Ceara19 you say that medicaid already knows about the pri****, so then shouldnt what Mrsk says already have been in effect? This doc that the child goes to was at first a "medicaid" doctor. After the medicaid had been denied the mother kept the same doctor anyway (i guess it was someone on her insurance's list?) And the confusion goes on and on. The mom purposly keeps leaving out details thinking he is stupid and wont tell him the full story on anything. They go to court on dec. 14, will this whole medicaid thing be brought out into the open by the judge? or should the father go ahead and tell his lawyer about all this mess so he can bring it to the judges attention? Should the judge already know about the technical part of medicaid or does the father need to call ahead of time and get the scoop and then call his lawyer with the info? Sorry for all the questions but every bit of advice thus far just keeps them coming.

 

[ceara19]

Ok this is where I am confused. She has a $163 outstanding balance at her child's doctor. If what MrsK says is true, then shouldnt medicaid have already paid this? The mother usually says "oops" and says she has just forgotten to pay the balance. Nothing has ever been mentioned about medicaid picking up the tab for what the pri**** hasnt covered. So, let me put all this together. Ceara19 you say that medicaid already knows about the pri****, so then shouldnt what Mrsk says already have been in effect? This doc that the child goes to was at first a "medicaid" doctor. After the medicaid had been denied the mother kept the same doctor anyway (i guess it was someone on her insurance's list?) And the confusion goes on and on. The mom purposly keeps leaving out details thinking he is stupid and wont tell him the full story on anything. They go to court on dec. 14, will this whole medicaid thing be brought out into the open by the judge? or should the father go ahead and tell his lawyer about all this mess so he can bring it to the judges attention? Should the judge already know about the technical part of medicaid or does the father need to call ahead of time and get the scoop and then call his lawyer with the info? Sorry for all the questions but every bit of advice thus far just keeps them coming.

Sorry it took so long to answer your question, I've been on vacation. Dad can go down to the local Health and Human Services Office, bring a copy of the child's irth certificate as proof he is the father (he can get this at the Vital Statistic's office, and they will be ale to tell him whether or not the child is actually on Medicaid. If she is, dad can verify that they know about the private insurance.

Medicaid is renewed every 6 months and the caseworker verifies at each renwal whether or not the child has other insurance. Some Dr's offices also check this info at the time of the appt.

As far as the outstanding bill, if it was incurred more than 3 months BEFORE Medicaid went into effect, Medicaid will not pay it. Mom could be lying about the Medicaid.

It's not really goung to make a difference in court whether or not the child is on Medicaid, the NCP will still be ordered to provide insurance.

The state has the right to bill the NCP for the medical bills they pay. Usually, this is only done when the NCP doesn't provide court ordered insurance. Once in a while, they will bill the NCP for 50% of what they pay, but it doesn't happen often and it is typically only done when the state has paid alot for medical/dental bills.

As for the "medicaid doctor", alot of people refer to any doctor that accepts Medicaid as a "medicaid Dr". Almost all dr's that accept Medicaid also accept patients with private or no insurance, but there are some dr's that do not accept medicaid at all.

Hope that answers your questions.

 

[usedstepmom]

You can report her to Medicaid, however, if she has had the insurance this whole time, the state will already know. In Texas, when applying for medicaid the state checks the applicant's name and social security # against the private insurance database to see if they are covered by any other policy. If Dad needs to bring the child to the Dr., he just needs to let them know that the child is on medicaid when they arrive. Most Dr.'s offices, hospitals and pharmacies can do a verification in less than a minute.

I have wondered about this same thing. My step-daughter's mother rarely ever uses the insurance that is provided by my husband. We think she is on the CHIP program, but how could she do that? How could be secondary insurance when my husband has "insurance" on her? I've been told it is fraud and we don't want to have any part of that. I have been told that it is and it isn't fraud.....which is it? How can we find out if she is on that program?

 

[beth_parr]

Ok this might not be honest and a bit mischevious but i don't think it hurts anyone so you may try what i did.

we needed to get stepsons medical records, we had no clue who his doctor but we knew he was on medicade. So i called up medicade pretending to be bio mom told them i had lost my purse with the cards in it. I gave them bio moms social address and phone. and they gave me his medicade id number. I then asked which doctor they had down for him, (just to make sure it was the one "I" requested). the lady was really nice on the phone and actually gave me more info than i needed. But it worked and we got the records and bio mom has no clue.

or if dad has joint legal custody he is entitled to all records on his kid. or he could just call, say hey im so and so's dad. I need to make a doc appt while child is in my care so I need her id number and doctor info. that might work.

hope it helps, beth

 

[Zephyr]

Ok this might not be honest and a bit mischevious but i don't think it hurts anyone so you may try what i did.

we needed to get stepsons medical records, we had no clue who his doctor but we knew he was on medicade. So i called up medicade pretending to be bio mom told them i had lost my purse with the cards in it. I gave them bio moms social address and phone. and they gave me his medicade id number. I then asked which doctor they had down for him, (just to make sure it was the one "I" requested). the lady was really nice on the phone and actually gave me more info than i needed. But it worked and we got the records and bio mom has no clue.

or if dad has joint legal custody he is entitled to all records on his kid. or he could just call, say hey im so and so's dad. I need to make a doc appt while child is in my care so I need her id number and doctor info. that might work.

hope it helps, beth

I would be apprehensive about inpersonating a bio parent to obtain confirential medical information....

 

[beth_parr]

i didn't say it was a honest thing to do. But you can always *67 when you call and hang up if things get sticky. in my case i just felt like it couldn't hurt to try. afterall I wasn't chageing anything and it wasn't like i was impersonating a police officer or anything. And no harm could come out of it as far as i can see, but i may be wrong. just thought i would throw it out there as an option.

 

[Zephyr]

i didn't say it was a honest thing to do. But you can always *67 when you call and hang up if things get sticky. in my case i just felt like it couldn't hurt to try. afterall I wasn't chageing anything and it wasn't like i was impersonating a police officer or anything. And no harm could come out of it as far as i can see, but i may be wrong. just thought i would throw it out there as an option.

I think that may be boardering on illegal, OP you should not follow this advice.


It doesn't matter that you weren't changing anythin, YOU didn't have a legal right that information.

 

[ceara19]

I have wondered about this same thing. My step-daughter's mother rarely ever uses the insurance that is provided by my husband. We think she is on the CHIP program, but how could she do that? How could be secondary insurance when my husband has "insurance" on her? I've been told it is fraud and we don't want to have any part of that. I have been told that it is and it isn't fraud.....which is it? How can we find out if she is on that program?

Dad should be able to call Health and Human Services and find out (as long as the court order states he has access to medical records.) It's not fraud unless mom lied on the application. As long as Dad didn’t sign anything, he has nothing to worry about. I'm not sure what type of cross-reference check is done when applying for CHIPS, but it should be similar to the process for Medicaid.

Just because a person, especially a child, has private insurance, they are not automatically ineligible for subsidized aid. However, private insurance should ALWAYS be used as pri**** above any government programs.

If the child is on CHIPS, dad should have a copy of the card in case he ever has to bring the child to the doctor or hospital during visitation. I don’t know what kind of relationship you have with mom, but you could just ask mom if there is any info you might need to have in case of a medical or other emergency.