Medicare, Medicaid, Life and Health Insurance/Pregnancy Medicaid

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Question
Hi Cindy.  My daughter, who is in her late twenties, is still covered under our insurance due to an emotional disorder.  She is pregnant,applied for pregnancy medicaid and was approved with prior coverage dating back to July.  Unfortunately, she began seeing an OB/GYN that is not a Medicaid provider. She is now five months into her pregnancy and would really prefer not to change doctors.  Is it possible for a patient to file a claim directly to Medicaid for her pregnancy expenses not covered by BCBS which amount to around $400.00 plus co-pays?  Would she be better off switching totally to Medicaid and finding a new doctor? I know that this is getting complicated, but we have never had any experience dealing with Medicaid. How does she go about filing prior medical expenses with her primary care physician who is an approved provider?  She is employed, but her employer does not offer her insurance because she is considered part-time.  We are located in Georgia.  Thank you for any assistance that you can offer.

Answer
Hi Lou.  The easiest solution would be to continue care with her preferred Dr. under your insurance.  Obviously any expenses or copays are your responsibility.  If you cannot continue this cost, then she would have to find a Medicaid OB/GYN.  

I found this on the Georgia Medicaid website:

Q. Can I see a doctor before Medicaid eligibility is determined?
A. You will be responsible for any bills, if you do not communicate with your doctor about your application for Medicaid. It will be the doctor’s decision to accept you as a Medicaid patient and file your claim(s) retroactively, if you become eligible. Once you have been determined eligible for Medicaid by the DFCS, you will receive an approval notice in the mail. The medical provider can use information from the approval notice to confirm your eligibility while you are waiting to receive your Medicaid card.


I would communicate with her Medicaid worker to see how you might be reimbursed for claims accrued since July.  

I hope this helps.

Medicare, Medicaid, Life and Health Insurance

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Cindy Hopp

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As an expert in Medicare supplemental insurance, I can help you decide which plan is best for you. If you are turning 65 or your rates are just too high, let me shop for you and give you your options. I can also assist the under-65 for their health insurance options. Please include the State you live in.

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