Expert: Bennie719 - 7/8/2009

Question
I have a friend who was outside with her boys. The older ones ran across
the street to the neighbors house. Before she could catch her 2yr old he
had run out too. An 18yr old was coming down the street and side swiped
the baby throwing him to the curb. The baby was taken to the hosiptal.
The driver had no insurance. She did have Medicaid but they are refusing
to pay. What opitions does she have now?

Answer
Hi Laurie,
I have some knowledge, but do not consider myself an expert
in health insurance.

As I understand medicaid, it is a federally funded state-run
program that provides medical assistance for individuals and
families.

Medicaid provides their insureds with a list of approved
procedures and a list of Doctors and other health care
providers that will accept Medicaid as payment in full.

If an insured receives treatment from someone who has not
agreed to accept medicaid as payment in full, then medicaid
will make their payment based on what they would have paid
to an approved doctor or other approved health care provider
and then that doctor or health care provider will bill the
insured for the balance.

In my opinion, there should be exceptions made for emergency
cases like this.  Perhaps there are, she will need to check
with medicaid.


There are other POSSIBLE sources for your friend to turn to
for help.  If the mother of the child has auto insurance OR
resides with someone who is a relative of the child and that
auto insurance policy has a coverage called Medical Payment
Coverage or Personal Injury Protection (PIP), she can turn
to that policy to have the medical bills paid.

If an auto policy exists under the above conditions, but
does not have medical or PIP but has Uninsured Motorists
coverage, she can turn to them with a "Pain & Suffering"
claim which would by far exceed the medical bills, giving
her money to pay the bills and have some left over.

If none of the above apply, then the final step is to file
small claims court action against both the driver and owner
of the car for the total amount of the medical bills and
on her baby's behalf for pain and suffering.

She might have to file two separate claims.  One for medical
bills and one for pain & suffering.

The small claims clerk at the county court house will usually
advise and assist her.

I hope that you have found this information helpful.  Your feed
back by rating my response will be appreciated.

Bennie
San Francisco Bay Area