Expert: LASHUNDA - 8/9/2009

Question
I have a very complicated situation that I need help with.  My ex is required to maintain insurance on our children through his private health insurance.  His employer funds a health reimbursement account through a third-party to meet up with his high-deductible plan.  My children, living with me, are covered under our states Medicaid program.  I recently had a situation where my son was seen in the emergency room for stitches at a participating provider for both the primary and medicaid.  The primary insurance was billed first and then the third-party HRA automatically sent out a payment for the uncovered balance before it was billed to medicaid.  I am getting different answers from medicaid as to whether it is acceptable for this provider to keep these payments as the HRA is now completely deleted and my ex has to now meet the remainder of the $3,800 deductible.  Some people say that this money should not have  been taken out as you cannot charge a medicaid recipient for medical services as a participating provider with medicaid.  Others state that medicaid is always the payor of last resort and thus the HRA must be billed first and depleted before medicaid will reimburse.  My son is not the only one on the primary insurance and therefore the HRA account is not strictly for him.


Answer
Hi Jenny.  Thanks for the question.  I agree that Medicaid is a payor of last resort.  I also agree that any company that will pay for medical services has to pay before Medicaid.  The deductible and the HRA is part of the medical benefit.  The HRA was put there to deter a burden for such a high deductible therefore, the HRA should pay before Medicaid.  I'm surprised that your son alone depleted the entire HRA because usually they have a set amount each family member can use.  In my own HRA, the family limit is $6000.00 but each family member can only use $2000.00 each.  You might want to check into that.

I hope I could help in some way to answer your questions.  Good luck.

Thanks,
LaShunda