Special Needs Son Denied Medical Treatment Because of a Secondary Insurance??

No, that is not legal at all. They should have a sign posted in their office where you can call the state dept. and complain. And I would.

They should have just billed your primary insurance and then given you a bill for the remaining balance, which you would submit to medicaid for reimbursement. I would talk to the office manager about this. It sounds like the women that you were talking to were confused about the proper protocol and made the fact that you had medicaid as a secondary insurance more of an issue than it really should have been.

Private doctors offices can refuse to see anyone they want...doesnt necessarly have to do with insurance. The only place that can not refuse to treat is an Emergency Room that receives federal money.

That being said I would call and ask to speak with your Doctor personally.

FYI: I have worked in an physicians office and in an ER for the past 14 years.

I would speak with the doctor directly about this treatment. Apparently you are an established patient and have not had this problem before. I would also ask to speak with the office manager about this (when children are not present). In all acutallity you can tell them that you no longer have the secondary insurance now and just the primary. You do not have to give them both.

It actually sounds normal to me. I worked in health care for several years and since we did not take Medicaid, we could not see anyone with it as an insurance listed. Even if the person offered to pay cash we could not accept. It was explained to me that the government issueing the Medicaid believes you need the coverage and therefore for us to accept a cash payment when the insurance is there is not something we were allowed to do.

I would see if you can find a doctor who can accept both insurances you have so you can get your son seen, work with the issueing agency and get the Medicaid policy discontinued. As for an office refusing treatment, they can. Only hospitals in case of emergency must treat and that is only to stablize and then they will transfer you to a hospital that takes your insurances. Good luck. I know this has to be a horrible time.

I don't know the answer to your insurance dilema. I just wanted you to know that I am keeping you and your son and your valiant efforts at taking the best care of him in my thoughts and prayers today. And I hope he is better soon. And I hope you find an answer. Mom's with sick kids shouldn't have to fight for the kid's health issues like this. It's just wrong.

CSHC is a medicaid program, but is not income based and is for anyone with a child with a qualifying chronic health issue for which they are seen by a specialist for that health issue. My son has a heart defect and my daughter asthma. It is a totally separate thing from medicaid for children who do not have adequate health insurance coverage. Several years ago, my husband thought he was checking online to see if we would qualify for our kids to be on Medicaid. By doing this apparently the kids were approved and put on medicaid! We had no idea until a doctors office told me and I was sure they were mistaken. When I called, I found out that yes, indeed they had all been put on this program! By then we did have other insurance so we tried to get off this program, but were informed that we were unable to dis-enroll for a year from the enrollment date, but when it came time to be evaluated to continue coverage, just to not re-enroll. That is what we did. It's very strange how the system works, but that is just the way it is. It is unfortunate that they won't work with you! I agree with another person who replied to you that it sounds like whoever you were talking to is confused or misinformed. Call the kent county MI Child office and find out what the policies are re: this and then if she is incorrect, call your dr's office back and tell her what you have discovered and if she still gives you a hard time, give her a number to call. If all else fails, especially as it sounds like your son has some pretty significant health issues and cannot afford to not be seen when he needs to, I would switch doc's. I would be happy to recommend our office. They are wonderful, and our doctor is very well known and respected in the area and I know they accept medicaid. Good luck!

I believe it's Federal Law that medical treatment can not be denied because of a patient's inability to pay for the treatment or their insurance. I would be looking for the State Medical Board's contact info. I would also talk to the news department of your local radio and TV stations and newspaper. The public outcry at this doctor's office will take care of it.

For your insurance dilema - ask to fill out an updated patient information sheet. Only list the one insurance. Don't list the medicaid.

M.

I just read this...I see it is from 2011 & my daughter has a special needs child & a friend sent us this story...because we are just now going through this same type of thing. I wept for you & your child as I read it allowed to my daughter. It is scary & a screwed up system. We are trying to get her baby seen asap because he is sick, & now can't be seen anymore by his regular doc because they were told to sign up for secondary & told how 'helpful' it would be. It's a lie!!! Now they are trying to cancel it. It's a nightmare. Especially when your baby is special needs (as you know). No one explained that secondary insurance does not really mean what it used to...that it takes over!! It's crazy! And backwards. I pray for our country & this messed up system we have going on. Because I know it is not the doctors, hospitals, etc fault. It's the way insurance is now. ...but, only the most needy seem to be getting hurt by it.
I hope by now, things are better with you..your family.. for you & your little one. ~KRH

We have been on CSHC before and just to clarify, that program IS a Medicaid program (the only need for qualification is having a special need they will cover, income does not matter). I would call the CSHC family phone line and ask them about the problem you're having. They should be able to explain to you whether your Dr's office has the right to refuse. The number is 1-800-359-3722. Or, you are in Grand Rapids too - you can call the Kent County Health Dept's Children's Special Health area. The state website for CSHC is http://www.michigan.gov/mdch/0,1607,7-###-###-####_4911_3....

I had a medical equipment supplier tell me they wouldn't fulfill my order when I placed it Dec 8th and my coverage ran out Dec 31st. I called the family line and they said the supplier never filled out the paperwork for preauthorization and that was not my problem. They said they would be happy to inform me on how to seek action against them. Luckily the supplier took it seriously when I said I would be calling CSHC to complain and they shipped my order at no cost to me or to CSHC.

I cannot believe that they refused you due to a payment issue, especially when you said you would even pay cash, and you are already a patient at the practice. I would call their main office and ask for a name to write a complaint to, and then perhaps ask a lawyer for help as well. This sounds OUTRAGEOUS!!! If you were not already a patient I could see that they do not want to take in someone with an emergency that they do not know, but even then if the child is in distress you would think someone would come out to say hello and help. I would most certainly complain in a very controlled, possibly legal, way so that this does not happen again.

I think you are going to have to research the insurance issue from all sides. Talk to everyone involved, Doctors Office, Insurance Companies, State Insurance board, etc. with the goal of just finding out what the situation is. When you talk to the doctors office, stay calm and matter of fact. If you accuse them off the bat of doing something wrong they could very well stop talking and not help you. Your goal is to find out the details of this mess, no easy task, it may be coming from the Insurance Company and Medicaid. As far as refusing treatment I think they can only not refuse treatment for someone in an emergency life saving situation, you'll need to confirm this with the Medical Board or further research. It isn't right at all but you have to look at this as a fact finding job that is going to more than likely be a Pain in the youknowwhat.

Last - How do you know he needs an antibiotic? Has he been tested and a bacterial infection confirmed? Antibiotics only work on bacterial infections. He should be watched to make sure it doesn't go there but if he his body can deal with what's going on without antibiotics it is actually better for him. My Dad had a severe drug injury that left him hearing impaired and with Arthritis from the overprescription of an antibiotic. I know his situation is not the norm but in my mind any drug that is improperly used CAN be an "awful thing". Antibiotics are a Godsend but don't push for them when not needed.

Yes, it is legal for a doctor's office to deny treatment based on your insurance- even if you are willing to pay in cash.

Having said that, if you feel very strongly that your son's medical condition is "emergency", then call an ambulance and have him taken to the hospital as an "emergency". They will treat him first and sort-out the bills later.

I think it has something to do with the Medicaid laws. My brother has Medicaid due to a disability and the same thing has happened with him. He has had doctors refuse to see him since they weren't on the medicaid list. Even when he offered to pay cash and them not file. They all told him that they would lose their medicaid funding if they were found out. I don't think this is right ! I believe a patient has a right to see whatever doctor they want to see - and use whatever payment method they want. If they want to pay cash and not involve the insurance company - great. If their insurance company is accepted by that office - use it.