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Giving up Insurance in favor of Medicaid
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amother
White


 

Post Tue, Jan 21 2020, 4:40 pm
amother [ Floralwhite ] wrote:
I know many people and they got great care. High risk OB you can’t really get in Medicaid unless you use Columbia clinic verses a private doctor. But in NY almost all specialist you can get good ones on Medicaid

When I had a high risk pregnancy, it did not pay to go on private insurance. I needed an expensive medication throughout pregnancy and non stress tests. After figuring out the cost, I decided to pay for the dr out of pocket and everything else got covered by Medicaid.
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amother
Hotpink


 

Post Tue, Jan 21 2020, 11:59 pm
In ny.

I've seen specialists, all fully covered. I was on a new medication, super expensive, for a year- all fully covered. Surgery, all fully covered. Bh!

Mental health- that's a different story
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amother
Khaki


 

Post Wed, Jan 22 2020, 6:37 am
It seems like everyone here loves medicaid. Idk. I'm on it. Dont love it. Havent found a decent dentist that takes it. One of my kids needed aba and most private insurance would cover it but Medicaid doesnt.
My ob and pediatrician take it but a lot of other drs are second class. Hard time finding a dermatologist in Brooklyn so paid oop.
Also my orthopedist didnt take it. One that took it had to wait 3 hours by.
Love not having co pays but hate having to go to the second class drs
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amother
Seashell


 

Post Wed, Jan 22 2020, 6:47 am
amother [ Floralwhite ] wrote:
I know many people and they got great care. High risk OB you can’t really get in Medicaid unless you use Columbia clinic verses a private doctor. But in NY almost all specialist you can get good ones on Medicaid


Of course u can get a high risk ob or mfm covered by medicaid.
U may have to see them in a clinic and not in their private office but you can still get care under them.
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amother
Yellow


 

Post Wed, Jan 22 2020, 6:49 am
My sister had a newborn baby with a serious issue who needed surgery. She paid for a few months of real insurance through her work and flew out of state for top treatment.

Why don't you speak to the medical referral hotlines, forgot the specific names of them. I'm sure they can tell you.
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et27




 
 
    
 

Post Wed, Jan 22 2020, 6:52 am
amother [ Yellow ] wrote:
My sister had a newborn baby with a serious issue who needed surgery. She paid for a few months of real insurance through her work and flew out of state for top treatment.

Why don't you speak to the medical referral hotlines, forgot the specific names of them. I'm sure they can tell you.


I think that's a good idea. Thank you!
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et27




 
 
    
 

Post Wed, Jan 22 2020, 6:53 am
amother [ Khaki ] wrote:
It seems like everyone here loves medicaid. Idk. I'm on it. Dont love it. Havent found a decent dentist that takes it. One of my kids needed aba and most private insurance would cover it but Medicaid doesnt.
My ob and pediatrician take it but a lot of other drs are second class. Hard time finding a dermatologist in Brooklyn so paid oop.
Also my orthopedist didnt take it. One that took it had to wait 3 hours by.
Love not having co pays but hate having to go to the second class drs


Going to second class doctors doesn't sound great. Do you mean specialists? Ex plastic surgeon? Or OB?
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amother
Red


 

Post Wed, Jan 22 2020, 7:03 am
et27 wrote:
OP here.
I live in NY. I'm hearing that in the case of a medical crisis even if the local hospitals take Medicaid, the best Dr or hospital may be out of state or not accept it. Has anyone had an experience where they felt limited in NY or wished they access to Drs that don't take Medicaid?


Interesting thread, but a lot of doctors in nyc take Medicaid as my friends have it and seem to find good drs that take it. But, do they have access to the best?? I don't know, but I do know that even my private insurance is not accepted by the "best" doctors. Maybe you have a very good private insurance???

So it really depends if you have very good private insurance and which drs you want to go to.
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et27




 
 
    
 

Post Wed, Jan 22 2020, 7:07 am
amother [ Yellow ] wrote:
My sister had a newborn baby with a serious issue who needed surgery. She paid for a few months of real insurance through her work and flew out of state for top treatment.

Why don't you speak to the medical referral hotlines, forgot the specific names of them. I'm sure they can tell you.


Also just as an aside, a new baby is a qualifying event so you can choose to opt in to private insurance at that point. A surgery or illness would not allow you to join private insurance unless you got a new job or had a life event at the same time...
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amother
Powderblue


 

Post Wed, Jan 22 2020, 7:55 am
We had a major medical crisis (long term) and got medicaid for that family member, even though we have private insurance. Medicaid covers more. No co-pays. My very expensive insurance has high deductibles, and no eye care or dentist coverage. Medicaid is the best insurance.
When we looked for a good primary doctor in Brooklyn, there was one very good one that accepts Medicaid but not Oxford.
Private insurance reimburses so poorly that some good doctors will not accept it. We keep saying that the govt. should give us the option of paying premiums for Medicaid coverage.
Good luck with your decision.
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amother
Bisque


 

Post Wed, Jan 22 2020, 9:25 am
In ny, if you have straight medicaid, you can get great coverage in the hospitals. However, nowadays, you must choose a medicaid hmo and those are not so great. For a long time, pretty much everyone in brooklyn had americhoice, which had great coverage for patients. The reason they gave so much. Is because they reimbursed drs/meds very little. Ultimately it backfired and most drs pharmacies stopped accepting it, forcing people to switch to fidelis, healthfirst or empire blue cross - all of which have very limited coverage.

If your child/adult is very ill, you can still get treated at most nyc good hospitals, but you are limited to whoever is on call. Majority hospitals now have hospitalists/pa's who are in charge of your care. Some are great, many are not. You can get your own Dr to consult but hospital staff will generally not cooperate with them. In fact, if your Dr has admitting privileges at this hospital, even if he is part of this particular team, he is generally not allowed by the hospital to get himself involved in your care if he is not on call. This applies to pretty much all the hospitals here including Columbia, nyu, Cornell . I mentioned these three simply because I personally experienced it in the past few months there.

So, the only thing to do is do research which plan has the best coverage for particular illness - drs, treatment needed and go from there. Speaking to medical referral places helps too.

One other thing I observed. Drs/pharmacies will generally advise you which insurance gives good coverage based on their experiences. Their perspective is based on how much they get reimburse. Whereas, the patient, may get more services with a different insurance Dr may not like because they get reimburse less. Case in point, americhoice vs empire blue cross. For example, americhoice will reimburse $3 for amoxil, empire will reimburse $8. So, americhoice will mostly approve for patients, empire will limit it. (this is example only, have specific meds but don't want to out myself). End result, pharmacy will like empire bcse reimburses better, patient has better deal with americhoice because approves more services....
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et27




 
 
    
 

Post Wed, Jan 22 2020, 10:01 am
amother [ Bisque ] wrote:
If your child/adult is very ill, you can still get treated at most nyc good hospitals, but you are limited to whoever is on call. Majority hospitals now have hospitalists/pa's who are in charge of your care. Some are great, many are not. You can get your own Dr to consult but hospital staff will generally not cooperate with them. In fact, if your Dr has admitting privileges at this hospital, even if he is part of this particular team, he is generally not allowed by the hospital to get himself involved in your care if he is not on call. This applies to pretty much all the hospitals here including Columbia, nyu, Cornell . I mentioned these three simply because I personally experienced it in the past few months there


Is that not the case if you have private insurance or doesn't make a difference?
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amother
Slateblue


 

Post Wed, Jan 22 2020, 10:21 am
et27 wrote:
Is that not the case if you have private insurance or doesn't make a difference?


I can only speak to using private insurance and doctors selected by patient.

In my experience, your own physicians and specialists take the lead in terms of treating you in the hospital. They leave orders which are followed by all the medical personnel in the hospital including the staff doctors. If there is a crisis, they would of course treat but they would also contact the patient’s doctors to confirm treatment. They generally visit their patients in the hospital frequently and often every day.

Hospital doctors may or may not be good doctors but they generally don’t have the experience of private physicians and they definitely don’t have a history of knowing the patient which is extremely helpful when one is discussing options.
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et27




 
 
    
 

Post Wed, Jan 22 2020, 10:24 am
amother [ Slateblue ] wrote:
I can only speak to using private insurance and doctors selected by patient.

In my experience, your own physicians and specialists take the lead in terms of treating you in the hospital. They leave orders which are followed by all the medical personnel in the hospital including the staff doctors. If there is a crisis, they would of course treat but they would also contact the patient’s doctors to confirm treatment. They generally visit their patients in the hospital frequently and often every day.

Hospital doctors may or may not be good doctors but they generally don’t have the experience of private physicians and they definitely don’t have a history of knowing the patient which is extremely helpful when one is discussing options.


So if I understand correctly, you can be treated in the same Hospital through Medicaid and through private insurance however on Medicaid one may be limited to whoever is on call whereas on private insurance the doctor that you are working with should be managing the case
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tryinghard




 
 
    
 

Post Wed, Jan 22 2020, 10:28 am
amother [ Slateblue ] wrote:
Do you mean out of network or out of state. With very few exceptions, most insurance plans have some kind of preferred providers which are limited to in one state. This is because it is almost impossible for insurance companies to negotiate fees with an unlimited number of doctors.

Comparing Medicaid to private insurance is impossible since it really depends on where you are located and how "good" your private insurance is. However, unless you are signed up to an HMO most plans have the option to go out of network. It might cost you a bit more but you can pay for a specialist of your choice who is out of network. My experience is that the co-pay might be higher (e.g. 50%) and less goes towards meeting your deductible.

If seeing the "top" doctor and freedom of choice is critical to you, I would advise against Medicaid. Medicaid compensation is below rates that private insurers pay doctors so most doctors would not take it if they had any choice.

It is only after joining imamother that I realized there were actually places where a substantial number of doctors did take Medicaid. Presumably this is limited to certain areas of Brooklyn, Lakewood and Monsey with substantial numbers of from people on Medicaid. In every other area, Medicaid doctors are few and far between because it is so low paying. Presumably in Brooklyn, Lakewood and Monsey a doctor is almost forced to take Medicaid or else he or she would have difficult getting sufficient patients.

The lack of Medicaid doctors in most doctors is well substantiated.


I found the opposite to be true. I live in Western NY, and I don't know of any doctors that won't take the Medicaid HMOs. It's very rare here for anyone to have straight Medicaid for more than a month or so, and the HMOs were negotiated such that any doctor who wants to take ANY HMO from a given company MUST accept the Medicaid HMO as well.
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amother
Maroon


 

Post Wed, Jan 22 2020, 11:57 am
et27 wrote:
Has anyone experienced a serious illness or injury while on Medicaid?


I have a child with chronic health issues. After every visit to a specialist and after every hospital stay I'm so grateful to have Medicaid for her (I do have a small monthly premium).
I have private insurance for myself and I'm still struggling to pay off the debt accumulated after my ER visit 2 years ago.
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amother
Oak


 

Post Wed, Jan 22 2020, 1:45 pm
et27 wrote:
Has anyone experienced a serious illness or injury while on Medicaid?

Yes me. Thank god I was on private insurance too at the time. I landed up in the hospital and it was great that Medicaid covered but then I needed to be transferred to a different hospital and the only option was out of state. I’m so grateful for private insurance.
To put it into one sentence, no Medicaid will not cover if you have a huge crisis, but yes, it’s usually adequate.
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amother
Linen


 

Post Wed, Jan 22 2020, 2:08 pm
amother [ Oak ] wrote:
Yes me. Thank god I was on private insurance too at the time. I landed up in the hospital and it was great that Medicaid covered but then I needed to be transferred to a different hospital and the only option was out of state. I’m so grateful for private insurance.
To put it into one sentence, no Medicaid will not cover if you have a huge crisis, but yes, it’s usually adequate.


We had a crisis as big as crisis can get, and Medicaid covered everything including hospital transfers. The only thing they didn't cover was a certain test we wanted to do but Medicaid didn't deem it necessary, so we paid for it.
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et27




 
 
    
 

Post Wed, Jan 22 2020, 2:13 pm
amother [ Oak ] wrote:
Yes me. Thank god I was on private insurance too at the time. I landed up in the hospital and it was great that Medicaid covered but then I needed to be transferred to a different hospital and the only option was out of state. I’m so grateful for private insurance.
To put it into one sentence, no Medicaid will not cover if you have a huge crisis, but yes, it’s usually adequate.


Thanks for sharing. Was this in NY?
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amother
Seashell


 

Post Wed, Jan 22 2020, 2:20 pm
et27 wrote:
Going to second class doctors doesn't sound great. Do you mean specialists? Ex plastic surgeon? Or OB?


Why dont you call you call up top specialists near you and ask which insurance they take?
I'm in NYC, and I know top MFMs, heads of orthopedic surgery at their hospital and others who take medicaid. I wouldn't call that second rate.
Call the desk your worried about and see if they take it.
(I do like having private insurance because I don't have to wait for the day their in their clinic... The availability is much better.
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