Question for those with Medicaid Coverage

Alyssa · Jul 3, 2007

Since before the diagnosis of CF my kids have always had great coverage through group employee purchased health care (Cigna) Everything has been paid really well and relatively speaking we have not had much out of pocket expense.

We are in a weird situation with health insurance at the moment due to my husband's health & employment status (long story) but the short story is:

our son needs to transfer his care from the state of WA (Children's Hospital - Seattle) to the state of ND (St. Alexius Heart & Lung - Bismarck). I would like to run him through all the base line stuff here, particularly PFT's & chest x-ray.

He also has state approval for Medicaid coverage (considered disabled due to autism, not CF) I have transferred Medicaid from WA to ND

We rarely used the Medicaid of WA because Cigna covered so well. But now Cigna will be considered out of network and will leave us with some high deductibles and co-insurance. I am assuming Medicaid will pick all of this up as secondary coverage.

Money has never been an issue when it came to running tests (PFT's, x-rays, CT scans etc) because Cigna paid so well. We will have Cigna for a couple more months (out of network if done in ND rather than WA) then I think he will be Medicaid only.

So............ I'm finally getting to my question...... since I have only experienced having Cigna pay for everything, how well does Medicaid cover things and more specifically, have you ever felt like you DIDN'T get the best treatments or tests because Medicaid was your only health insurance?

Alyssa · Jul 3, 2007

Since before the diagnosis of CF my kids have always had great coverage through group employee purchased health care (Cigna) Everything has been paid really well and relatively speaking we have not had much out of pocket expense.

We are in a weird situation with health insurance at the moment due to my husband's health & employment status (long story) but the short story is:

our son needs to transfer his care from the state of WA (Children's Hospital - Seattle) to the state of ND (St. Alexius Heart & Lung - Bismarck). I would like to run him through all the base line stuff here, particularly PFT's & chest x-ray.

He also has state approval for Medicaid coverage (considered disabled due to autism, not CF) I have transferred Medicaid from WA to ND

We rarely used the Medicaid of WA because Cigna covered so well. But now Cigna will be considered out of network and will leave us with some high deductibles and co-insurance. I am assuming Medicaid will pick all of this up as secondary coverage.

Money has never been an issue when it came to running tests (PFT's, x-rays, CT scans etc) because Cigna paid so well. We will have Cigna for a couple more months (out of network if done in ND rather than WA) then I think he will be Medicaid only.

So............ I'm finally getting to my question...... since I have only experienced having Cigna pay for everything, how well does Medicaid cover things and more specifically, have you ever felt like you DIDN'T get the best treatments or tests because Medicaid was your only health insurance?

Alyssa · Jul 3, 2007

Since before the diagnosis of CF my kids have always had great coverage through group employee purchased health care (Cigna) Everything has been paid really well and relatively speaking we have not had much out of pocket expense.

We are in a weird situation with health insurance at the moment due to my husband's health & employment status (long story) but the short story is:

our son needs to transfer his care from the state of WA (Children's Hospital - Seattle) to the state of ND (St. Alexius Heart & Lung - Bismarck). I would like to run him through all the base line stuff here, particularly PFT's & chest x-ray.

He also has state approval for Medicaid coverage (considered disabled due to autism, not CF) I have transferred Medicaid from WA to ND

We rarely used the Medicaid of WA because Cigna covered so well. But now Cigna will be considered out of network and will leave us with some high deductibles and co-insurance. I am assuming Medicaid will pick all of this up as secondary coverage.

Money has never been an issue when it came to running tests (PFT's, x-rays, CT scans etc) because Cigna paid so well. We will have Cigna for a couple more months (out of network if done in ND rather than WA) then I think he will be Medicaid only.

So............ I'm finally getting to my question...... since I have only experienced having Cigna pay for everything, how well does Medicaid cover things and more specifically, have you ever felt like you DIDN'T get the best treatments or tests because Medicaid was your only health insurance?

Alyssa · Jul 3, 2007

Since before the diagnosis of CF my kids have always had great coverage through group employee purchased health care (Cigna) Everything has been paid really well and relatively speaking we have not had much out of pocket expense.

We are in a weird situation with health insurance at the moment due to my husband's health & employment status (long story) but the short story is:

our son needs to transfer his care from the state of WA (Children's Hospital - Seattle) to the state of ND (St. Alexius Heart & Lung - Bismarck). I would like to run him through all the base line stuff here, particularly PFT's & chest x-ray.

He also has state approval for Medicaid coverage (considered disabled due to autism, not CF) I have transferred Medicaid from WA to ND

We rarely used the Medicaid of WA because Cigna covered so well. But now Cigna will be considered out of network and will leave us with some high deductibles and co-insurance. I am assuming Medicaid will pick all of this up as secondary coverage.

Money has never been an issue when it came to running tests (PFT's, x-rays, CT scans etc) because Cigna paid so well. We will have Cigna for a couple more months (out of network if done in ND rather than WA) then I think he will be Medicaid only.

So............ I'm finally getting to my question...... since I have only experienced having Cigna pay for everything, how well does Medicaid cover things and more specifically, have you ever felt like you DIDN'T get the best treatments or tests because Medicaid was your only health insurance?

Alyssa · Jul 3, 2007

Since before the diagnosis of CF my kids have always had great coverage through group employee purchased health care (Cigna) Everything has been paid really well and relatively speaking we have not had much out of pocket expense.

We are in a weird situation with health insurance at the moment due to my husband's health & employment status (long story) but the short story is:

our son needs to transfer his care from the state of WA (Children's Hospital - Seattle) to the state of ND (St. Alexius Heart & Lung - Bismarck). I would like to run him through all the base line stuff here, particularly PFT's & chest x-ray.

He also has state approval for Medicaid coverage (considered disabled due to autism, not CF) I have transferred Medicaid from WA to ND

We rarely used the Medicaid of WA because Cigna covered so well. But now Cigna will be considered out of network and will leave us with some high deductibles and co-insurance. I am assuming Medicaid will pick all of this up as secondary coverage.

Money has never been an issue when it came to running tests (PFT's, x-rays, CT scans etc) because Cigna paid so well. We will have Cigna for a couple more months (out of network if done in ND rather than WA) then I think he will be Medicaid only.

So............ I'm finally getting to my question...... since I have only experienced having Cigna pay for everything, how well does Medicaid cover things and more specifically, have you ever felt like you DIDN'T get the best treatments or tests because Medicaid was your only health insurance?

Alyssa · Jul 3, 2007

Since before the diagnosis of CF my kids have always had great coverage through group employee purchased health care (Cigna) Everything has been paid really well and relatively speaking we have not had much out of pocket expense.

We are in a weird situation with health insurance at the moment due to my husband's health & employment status (long story) but the short story is:

our son needs to transfer his care from the state of WA (Children's Hospital - Seattle) to the state of ND (St. Alexius Heart & Lung - Bismarck). I would like to run him through all the base line stuff here, particularly PFT's & chest x-ray.

He also has state approval for Medicaid coverage (considered disabled due to autism, not CF) I have transferred Medicaid from WA to ND

We rarely used the Medicaid of WA because Cigna covered so well. But now Cigna will be considered out of network and will leave us with some high deductibles and co-insurance. I am assuming Medicaid will pick all of this up as secondary coverage.

Money has never been an issue when it came to running tests (PFT's, x-rays, CT scans etc) because Cigna paid so well. We will have Cigna for a couple more months (out of network if done in ND rather than WA) then I think he will be Medicaid only.

So............ I'm finally getting to my question...... since I have only experienced having Cigna pay for everything, how well does Medicaid cover things and more specifically, have you ever felt like you DIDN'T get the best treatments or tests because Medicaid was your only health insurance?

NoExcuses · Jul 3, 2007

I'll tell you the persepct from the healthcare industry.

You are treated differently. And here's why. Medicaid most times doesn't pay as well as a PPO (it's about equal to an HMO in most cases).

Physicians know how much they're paid for seeing a patient. Many physicians who take private insurance won't take Medicaid because it pays so poorly. So you'll get more time with a doc who takes only private insurance.

Another business model is the low cost/high volume model. Those docs who take HMO or Medicaid see a very high volume of patients and this is how they make money. Patient doesn't pay as much, but guess what? Oh yes, you get what you pay for. That little rule applies in any aspect of life. Even healthcare.

Plus with Medicaid, often times you have to get referrals for specialists, tests, etc. That can take time. And often time is important in healthcare. As you've seen, that's not the case with a PPO.

I would weigh your options long and hard before you jump on the Medicaid bandwagon. You get what you pay for

NoExcuses · Jul 3, 2007

I'll tell you the persepct from the healthcare industry.

You are treated differently. And here's why. Medicaid most times doesn't pay as well as a PPO (it's about equal to an HMO in most cases).

Physicians know how much they're paid for seeing a patient. Many physicians who take private insurance won't take Medicaid because it pays so poorly. So you'll get more time with a doc who takes only private insurance.

Another business model is the low cost/high volume model. Those docs who take HMO or Medicaid see a very high volume of patients and this is how they make money. Patient doesn't pay as much, but guess what? Oh yes, you get what you pay for. That little rule applies in any aspect of life. Even healthcare.

Plus with Medicaid, often times you have to get referrals for specialists, tests, etc. That can take time. And often time is important in healthcare. As you've seen, that's not the case with a PPO.

I would weigh your options long and hard before you jump on the Medicaid bandwagon. You get what you pay for

NoExcuses · Jul 3, 2007

I'll tell you the persepct from the healthcare industry.

You are treated differently. And here's why. Medicaid most times doesn't pay as well as a PPO (it's about equal to an HMO in most cases).

Physicians know how much they're paid for seeing a patient. Many physicians who take private insurance won't take Medicaid because it pays so poorly. So you'll get more time with a doc who takes only private insurance.

Another business model is the low cost/high volume model. Those docs who take HMO or Medicaid see a very high volume of patients and this is how they make money. Patient doesn't pay as much, but guess what? Oh yes, you get what you pay for. That little rule applies in any aspect of life. Even healthcare.

Plus with Medicaid, often times you have to get referrals for specialists, tests, etc. That can take time. And often time is important in healthcare. As you've seen, that's not the case with a PPO.

I would weigh your options long and hard before you jump on the Medicaid bandwagon. You get what you pay for

NoExcuses · Jul 3, 2007

I'll tell you the persepct from the healthcare industry.

You are treated differently. And here's why. Medicaid most times doesn't pay as well as a PPO (it's about equal to an HMO in most cases).

Physicians know how much they're paid for seeing a patient. Many physicians who take private insurance won't take Medicaid because it pays so poorly. So you'll get more time with a doc who takes only private insurance.

Another business model is the low cost/high volume model. Those docs who take HMO or Medicaid see a very high volume of patients and this is how they make money. Patient doesn't pay as much, but guess what? Oh yes, you get what you pay for. That little rule applies in any aspect of life. Even healthcare.

Plus with Medicaid, often times you have to get referrals for specialists, tests, etc. That can take time. And often time is important in healthcare. As you've seen, that's not the case with a PPO.

I would weigh your options long and hard before you jump on the Medicaid bandwagon. You get what you pay for

NoExcuses · Jul 3, 2007

I'll tell you the persepct from the healthcare industry.

You are treated differently. And here's why. Medicaid most times doesn't pay as well as a PPO (it's about equal to an HMO in most cases).

Physicians know how much they're paid for seeing a patient. Many physicians who take private insurance won't take Medicaid because it pays so poorly. So you'll get more time with a doc who takes only private insurance.

Another business model is the low cost/high volume model. Those docs who take HMO or Medicaid see a very high volume of patients and this is how they make money. Patient doesn't pay as much, but guess what? Oh yes, you get what you pay for. That little rule applies in any aspect of life. Even healthcare.

Plus with Medicaid, often times you have to get referrals for specialists, tests, etc. That can take time. And often time is important in healthcare. As you've seen, that's not the case with a PPO.

I would weigh your options long and hard before you jump on the Medicaid bandwagon. You get what you pay for

NoExcuses · Jul 3, 2007

I'll tell you the persepct from the healthcare industry.

You are treated differently. And here's why. Medicaid most times doesn't pay as well as a PPO (it's about equal to an HMO in most cases).

Physicians know how much they're paid for seeing a patient. Many physicians who take private insurance won't take Medicaid because it pays so poorly. So you'll get more time with a doc who takes only private insurance.

Another business model is the low cost/high volume model. Those docs who take HMO or Medicaid see a very high volume of patients and this is how they make money. Patient doesn't pay as much, but guess what? Oh yes, you get what you pay for. That little rule applies in any aspect of life. Even healthcare.

Plus with Medicaid, often times you have to get referrals for specialists, tests, etc. That can take time. And often time is important in healthcare. As you've seen, that's not the case with a PPO.

I would weigh your options long and hard before you jump on the Medicaid bandwagon. You get what you pay for

Alyssa · Jul 3, 2007