Medi-cal Secondary to Individual Insurance?
My baby's still in the hospital and has Medi-Cal (CA Medicaid) as a result of low birth weight (qualifying for SSI as his income is counted as 0 from low birth weight). I'm going to lose my employer coverage at the end of the month and we're taking that opportunity to cover my baby (just himself) under a different insurance (Blue Shield) by buying an individual plan directly from them.
My baby's still in the hospital and has Medi-Cal (CA Medicaid) as a result of low bitrth weight (qualifying for SSI as his income is counted as 0 from low birth weight). I'm going to lose my employer coverage at the end of the month and we're taking that opportunity to cover my baby (just himself) under a different insurance (Blue Shield) by buying an individual plan directly from them.t here: https://www.blueshieldca.com/en/home/help-and-resources/claims-payment-policy-qhp under "Coordination of Benefits", but it doesn't reference Medicaid specifically. In their Explanation of Coverage Document for their plans, it says "Medi-Cal always pays for Benefits last when you have coverage from more than one payor", which lines up with what the CA Department of Health Care Services says: https://www.dhcs.ca.gov/services/Documents/MCQMD/OHC-and-MMCE-Fact-Sheet.pdf, "Medi-Cal is the payer of last resort, which means in most cases Medi-Cal will be secondary to the OHC, covering allowable costs not paid by the primary insurance (typically wrap payments or co-pays) up to the Medi-Cal rate."test
So are the reps saying they won't coordinate w/ Medi-Cal wrong? Are we missing something?
submitted by /u/drphilbillpop
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