Attn:New Jerseyans-question abt pri ins and NJ Famcare

amother

Periwinkle

Thu, Nov 09 2017, 10:44 pm

I'm currently enrolled in BCBS health ins plan. I just became preg and have applied and been approved for NJ Fam Care.

I needed Medicaid as secondary Ins mainly because of my hosp stay when I give birth. BCBS will only cover like 70% so this will cover the 5k bal I wld otherwise have to pay oop

My question: would NJ Fam Care (I'm enrolled in the UHC Comm Plan) cover for deductibles and copays??

I just had a sonogram and had to pay for it in full as part of my deductible and wondering if UHCCP would cover the $400 bill?

cbsp

Fri, Nov 10 2017, 1:00 am

amother wrote:

They will cover as long as every provider /procedure is in network. You should also explain to the provider that they need to bill your secondary insurance and don't pay out of pocket for co-pays and deductibles - that's why you have the secondary insurance.

The provider is not going to like it though. Because the Medicaid insurance will only pay whatever they would have paid if they were the primary insurance, and the doctor can not legally ask you for the remainder. It's not that big of a discrepancy once you've met the deductible but until then...

On a different note, what obgyn takes UHCCP? That was the plan CHoP recommended for my son but good specialists for adults are few and far between.

Last edited by cbsp on Sat, Nov 11 2017, 11:34 pm; edited 1 time in total

amother

Periwinkle

Sat, Nov 11 2017, 10:03 pm

cbsp wrote:

They will cover as long as every provider /procedure is in network. You should also explain to the provider that they need to bill your secondary insurance and don't pay out of pocket for co-pays and deductibles - days why you have the secondary insurance.

The provider is not going to like it though. Because the Medicaid insurance will only pay whatever they would have paid if they were the primary insurance, and the doctor can not legally ask you for the remainder. It's not that big of a discrepancy once you've met the deductible but until then...

On a different note, what obgyn takes UHCCP? That was the plan CHoP recommended for my son but good specialists for adults are few and far between.

Thank you for the details. I guess that means I already lost out on getting back my $75 copay that I paid to take my ultrasound. when I get the rest of the bill since I still haven't met the deductible I will have Medicaid pay for that.

about your last question of which obgyn takes UHCCP-most in Lakewood do. I happen to be using a Dr. Baum in freehold-he takes UHCCP-one of the very few that came highly recommended even though he accepts Medicaid. but I'm still using BCBS coverage when I see him. the only downside of using him is that he is affliated with Jersey Shore hosp, not Monmouth where most of Lakewood women give birth. I happen to use him specifically for that reason (I do not like the idea of being in labor while my next door neighbor is in the next room and dh chavrusa's wife across the hall... you get the picture:)-BH my births are pretty uncomplicated since they only have a lvl 3 NICU while Monmouth has a lvl 4...

cbsp

Sat, Nov 11 2017, 11:34 pm

amother wrote:

I'm confused as to why, if he takes your Medicaid HMO, they're not billing Medicaid as secondary. Definitely make sure that all providers in the hospital take your insurances - most importantly the Medicaid HMO.

You also should be able to get the $75.00 copay reimbursed if the provider also takes your HMO (It's just easier if they do it upfront). Unless I misunderstood?

I'm in Passaic, haven't yet found a decent gyn that takes it. Even the ones from Lakewood that have an office near here don't accept it here. Oh well.