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Giving up Insurance in favor of Medicaid
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amother




Taupe
 

Post  Wed, Jan 22 2020, 2:43 pm
Most of my dc extensive, expensive cancer treatment for last couple of years were covered by Empire thru Medicaid in Memorial Sloan Kettering.
When he got diagnosed we spoke to RCCS about setting up a private insurance but they told us that Empire BCBS from Medicaid covers the most.
We had such hashgacha pratis that right before he got diagnosed the Healthplus HMO he was on switched over on their own to Empire.
Sometimes we did get bills & ignored it & seems like it was fine.
One chemo medication cost 17,000, each vial, as he was allergic to the standard. I don't know know how much insurance paid them but it wasn't on us.
For one treatment that cost a million dollars we had someone fight for couple of weeks for them to cover they gave us a hard time. My child stayed weeks in the hospital to wait for treatment while they were fighting.
Some treatments the hospital got grants for, if it was trial or research.
Idk how much the hospital waived if they didn't get covered by insurance. We gave them lots of business & my child was also their lab rat for new treatment/trials.
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dankbar




 
 
 
 

Post  Wed, Jan 22 2020, 2:48 pm
Why don't you call up all your doctors & facilities you currently use & check which insurances they take?
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amother




Beige
 

Post  Wed, Jan 22 2020, 3:09 pm
I have Medicaid in Brooklyn. I think it's great. Yes, there are some Doctors who don't take certain Medicaid insurances, but ... no Doctors take EVERY insurance. ALL the hospitals take Medicaid, though, and there are many world-class hospitals to choose from, with world-class Doctors. Of course, whatever insurance you have, there is always a chance that the one Dr. you really, really want won't take whatever insurance you have. But I have never felt deprived of options. And I have had a few serious medical issues and am currently 8 months pregnant:)
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Mama Bear




 
 
 
 

Post  Wed, Jan 22 2020, 7:16 pm
My son had a broken arm - all medicaid. another son a burn- all medicaid. It covers tons of dental. My son had his teeth taken care of under anesthesia. I was able to get cataract surgery on it too. In short, I was able to get everything I need for myself an all my kids taken care of on medicaid. the only thing I had to pay for was infertility stuff. and a high risk OB.
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Mama Bear




 
 
 
 

Post  Wed, Jan 22 2020, 7:18 pm
I forgot to add, I've been a therapist for 9 years. On medicaid.
Many HMOs cover infertility already as well. and aba therapy. and other things.
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amother




Puce
 

Post  Thu, Jan 23 2020, 4:59 am
Amother above mentioned that in hospital it will be whoever is on call when you’re on Medicaid. 2 things:
1) even on private insurance if your doc is not on call, he’s not on call. don’t think the hospital looks what insurance you have. The difference might be in you having a dr that doesn’t work in a group but has admitting rights in said hospital or you have their private celllnumber.
That being said-
2) my child's specialists (that we see in a clinic on Medicaid) are 99% of the time contacted by on call doc/ER/PICU even when they’re not on call (even when on vacation) So I don’t know if it’s just because we have the most amazing drs, always available via email or text or they love my child so much Wink but whatever it is, you can get very far with Medicaid. Yes, going out of state for care is a huge pain in the rear (an understatement) but in the long run We've gotten top care all along & was never limited with our local drs. We would’ve seen the same docs regardless.

We had one specialist that doesn’t accept Medicaid but he was able to negotiate s/t with them as out of network , but the fact that it’s a very rare specialty probably helped matters. (& yes, he’s a tzadik of a dr getting reimbursed pennies)

Another thing- main specialist who officially has 1 clinic day a week has come into the clinic on other days to see my child (we usually see dif Dr in the group when we come in dif clinic day but she has come in to see us too & side note- then thanks ME for coming in!)
My point of this long post that is written after almost a week of no sleep... is to say that if your life circumstances bring you to dropping private insurance, I don’t know if you should agonize so much over it... trust in Hashem all will be good- it’s not like you’re staying with no coverage either and if you have the option of adding private insurance back on in case of ch’v emergency it’s not entirely impossible (like we were given the choice of doing a late enrollment but paying back the last few months or something like that)
Good luck with your decision
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