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Mom Confessions Mom Confessions

Insurance Question- Paying out of pocket.

Anonymous
Posted by Anonymous
  • 7 Replies

My friend's 2 children are on Chips. She just found out that her pediatrician no longer takes the medical assistance. She is getting a new doctor but in the mean time her son needs his tetnus updated to allow him to participate in some school program.  He is autistic and she really wants him in this program but the new doctor can't get them in until they get the records switched. etc.

So even though money is tight she called her normal peds and said "I understand you no longer take MA but can I just pay out of pocket for the tetnus so he can join this program". The doctor's office said "no, that is insurance fraud, if you have state insurance you can't pay out of pocket."

Does anyone know why?

Posted by Anonymous on Feb. 18, 2013 at 2:22 PM
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Replies (1-7):
darcibeisheim
by Silver Member on Feb. 18, 2013 at 2:27 PM

 i have never heard of that... I always had the option of paying out of pocket for shots (my doctor doesn't do medicaid shots) or going to the health department..

Maybe call the health department or a walk in clinic... It would be cheaper in the long run.

angevil53
by on Feb. 18, 2013 at 2:28 PM
I'm assuming if they can't "afford" insurance the state assumes they can't afford medical procedures. She can go to the health dept though. My son did when the local dr didn't give shots in the office. Everyone in that town went there for shots.
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lucky35
by Member on Feb. 18, 2013 at 2:42 PM

doesn't the walgreens or cvs stores give out shots as well.  plus how is it insurance fraud if you are paying for the shot, so they shouldn't even be billed (medicaid)

Anonymous
by Anonymous 2 on Feb. 18, 2013 at 2:43 PM
If she pays out of pocket than she can end up losing the state insurance for her kids. Been there done that already.
Anonymous
by Anonymous 1 - Original Poster on Feb. 18, 2013 at 2:50 PM

Yes, the woman told her, Unfortunately it was one of those- Oh shit- forgot to got and state health dept is closed for presidents day..  She knows she messed up, I was just curious as to this rule. I had never heard anything like it before.


Quoting angevil53:

I'm assuming if they can't "afford" insurance the state assumes they can't afford medical procedures. She can go to the health dept though. My son did when the local dr didn't give shots in the office. Everyone in that town went there for shots.



Anonymous
by Anonymous 1 - Original Poster on Feb. 18, 2013 at 2:52 PM

Yes, exactly but do you know why?


Quoting Anonymous:

If she pays out of pocket than she can end up losing the state insurance for her kids. Been there done that already.



mom_3.0
by on Feb. 18, 2013 at 2:54 PM

This is true, actually. The theory is that if you can afford to pay out of pocket, then why are you getting Medicaid? 

She can take him to the Health Department with the Medicaid and get it done for free. 

Or, quickly get a new doctor and get it done with them.

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