private health insurance and medicaid coverage

[GrandmaOH]

What is the name of your state (only U.S. law)? OH

We are the custodial grandparents of a teenage boy. GS thought he could manipulate the system to force us to comply with his wishes. He called CPS and claimed 'mental abuse', after calls of 'physical abuse' got him nothing. It backfired on him, an inexperienced caseworker took him into custody because I refused to speak to her and requested a different caseworker. He's been in custody for 11 months now.
I was told to keep him on my health insurance. I did. They used my insurance for 2 months, then started using Medicaid. I have GREAT mental health coverage, it provides much more than Medicaid. They went 3 months using Medicaid and out of the blue used my insurance for an emergency run in April. I asked our lawyer to get a court order that ordered me to maintain my insurance because I feared I'd be in trouble since they hadn't been using my insurance, then used it. Got the order, I've maintained him on my insurance, my insurance is primary. Since that occurance in April they have not used my insurance again, not even to purchase his meds. All doctors and meds are being billed through Medicaid. I cover dental and vision out-of-pocket to keep him at the dentist and optometrist he has seen all his life.

Is this an abuse of Medicaid? Can/should it be reported? Will I be held responsible for their misuse of the insurance coverage if there is an investigation?

 

[RRevak]

When an individual has both private insurance and medicaid, the private MUST be billed FIRST and then anything after is billed to medicaid. Are you 100% certain they caseworker is aware he has private insurance and the necessaries it covers?

 

[RRevak]

Also, is medicaid aware he also has private insurance? Often, families with higher incomes aren't able to be eligible for medicaid if private insurance exists that covers hospitalizations and doctors visits. Have you verified that medicaid knows about his primary insurance?

 

[GrandmaOH]

I gave them a new card in July and reiterated to Caseworker to use my insurance. Foster family was informed. Foster family thinks caseworker was going to 'fix' the billing. I don't know what the caseworker thinks. It was a different caseworker in April, I assume she arranged for the hospital to bill my insurance.

I have repeatedly requested they use doctors and therapists listed on my insurance so he may continue with the same doctors if/when he is returned home. He will not be eligible for Medicaid if/when he returns home. Half of them are Medicaid and do not accept my insurance(a well-known company). They continue to only bill Medicaid no matter what.

When I spoke to them about using my insurance I told them I did not have Dental or Vision, but to use our dentist and I would pay the dentist directly. They took him to another dentist that accepts my insurer, but 'found out I didn't have dental'. I called the caseworker again, she called the foster family and GS was taken to our dentist & I paid. This is an example of the confusion they have over using private insurance.

I do not know if Medicaid knows he has private insurance.

 

[ecmst12]

Contact medicaid and let them know about the primary policy. They will handle the reimbursement.