HMO vs. Medicaid?

A place to discuss the many medical issues that may come up during the course of a CPS case.

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Joined: Wed Apr 16, 2008 7:15 pm

HMO vs. Medicaid?

Postby searcher » Thu May 15, 2008 10:48 am

We have wonderful insurance. At the first hearing after our children were removed, I let our lawyer know that we had insurance, asked why our children were issued medicaid cards and offered the insurance information so that the children could use our insurance.

I was told by the lawyer that if the children are in care after 6 months, then we would be asked for the insurance information. But not before.

Our children are with a caregiver who has the same insurance, so she would be able to easily find doctors for the children. The pediatrician our children are currently seeing is the one that she uses for her children, so he/she would take the insurance.

Since they have been in her care, they have been ill several times including needing to be taken to specialists for certain care. Our insurance would offer the children accessibility to better doctors and we believe much less of a hassle for the caregiver than dealing with medicaid.

Also a concern is the fact that the children have insurance already and Medicaid does not have the info so that our insurnace would at least be primary. Could we be liable for the costs to Medicaid for the children's care? Could we be accused of keeping information away from Medicaid since they don't have our insurance info? (We know they don't have the info because no one has ever asked for it.)

Can we (through our lawyer) force the issue without ticking off CPS? Has anyone had any success with their children maintaining their own insurance coverage while in care?


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Location: WV

Postby debbiescalese » Thu May 15, 2008 1:51 pm

This is what you do first notify the worker of the med coverage, photo copy the cards etc and send them to her cert mail. Then call the medicaid fraud hotline and report that cps has custody of your children at the time and you have proof that you gave them the med info for thier health insurance yet they refuse to use it. Medicaid handles it from there they varify the info and if true they the use of the card then cps will try to bill it to your insurance and if the doctors are not providers under your insurance they may not take it. In that case cps will tell you your responcible since you gave them the info and they failed to follow proper proceedure you may have to fight it but you'll win in the end. They want to use thier doctors who give cps version of events not yours who have known the kids for years and will give independant medical opinion.

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Postby Marina » Thu May 15, 2008 3:36 pm


Yes, this is Medicaid fraud. Report it. Call them.


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