AboutJohn Pedit Expertise Am an expert on Medicare, Medicare HMOs, and Medicare supplemental insurance. Also have extensive knowledge of Medicare especially in Mich. Have knowledge of COBRA and the Portability Act
Experience
Past/Present clients Council about 300 persons yearly and do many presentations on Medicare
Question I am upset. While visiting my family in CA, I took my 5yr old triplets to the ER for upper resp. Infect's. BEFORE they were seen, I asked if they would take TX Medicaid. Filled out ALL the paper work and gave copies of my proof. The young girl at the front said yes. We can take it! Now, the billing Co. wants 300.00 per kid from me!! They said they are not contracted to take TX Med. claims. I spoke to a manager, and they will not budge--what do I do??
Answer Hi Lisa
Because State money is used for approximately half of the Medicare funds in each State, the regulations are different in each State, Coverage is only for the State concerned. Therefore your Tx Medicaid will not cover the CA bills. If the treatments were urgent care type, check with the case worker. If you have a denial from Medicaid, request a hearing,
You might try appealing the bill on the reason the girl told you it was covered. Unfortunately if she denies it, you will probably lose the appeal.
