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    Medicaid

    I have a disabled adult child (age 26) who is receiving SSI (never worked) and has Medicaid. Medicaid claims are being rejected; however, we do NOT receive any explanation of benefits advising why the claims have been denied. If you go online to look at the claims, the only "explanation" is denied.
    Aren't insurance companies (in this case the Medicaid servicer) suppose to give written explanations for claims be it payment or denial?
    Bills are piling up quickly......

    #2
    its2much,

    Medicaid authorization and payment issues are problematic, and difficult to resolve. There are a few steps I would recommend, if you have not already done so. Initially, depending on how the denial is issued and the provider's relationship with Medicaid, there may be a balance billing issue. That is, the provider may be required to accept what Medicaid says they can accept. I'd make the following inquiries: (1) contact the provider's billing office, and confirm their understanding of the reason for denial, as well as inquire as to how they are permitted to 'balance bill' your son for services Medicaid has denied; (2) contact your US congressman for assistance with getting an explanation from Medicaid. The Congressman is your outlet to the government, and should have an employee specializing in 'constituent services' who may be able to help.

    Best of luck!

    -Jamie
    Attorney Jamie R. Hall's practice is focused on assisting individuals with claims and appeals for Social Security Disability and Long Term Disability benefits. He has assisted claimants nationwide, approximately half of whom are MS patients, from his Pennsylvania and Ohio locations. **No attorney/client relationship is created by this communication, and information provided herein is not a substitute for formal advisement.**

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      #3
      Originally posted by TheMSLawyer View Post
      its2much,

      Medicaid authorization and payment issues are problematic, and difficult to resolve. There are a few steps I would recommend, if you have not already done so. Initially, depending on how the denial is issued and the provider's relationship with Medicaid, there may be a balance billing issue. That is, the provider may be required to accept what Medicaid says they can accept. I'd make the following inquiries: (1) contact the provider's billing office, and confirm their understanding of the reason for denial, as well as inquire as to how they are permitted to 'balance bill' your son for services Medicaid has denied; (2) contact your US congressman for assistance with getting an explanation from Medicaid. The Congressman is your outlet to the government, and should have an employee specializing in 'constituent services' who may be able to help.

      Best of luck!

      -Jamie
      This may be because you are receiving two benefits at the same time that is not advisory. You can go to your nearest SS office to collect more information on the topic.

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