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I have POA for my sister in law who used to live in PA. We live in DE. My husband and I do not need to navigate the health care system because we are both Veterans and receive all our health care free from the VA. So when it came time to bone up on all the tech issues relating to health coverage for my SIL it was a learning process with a heavy curve. I thought I had everything taken care of, then started receiving bills from the doctor for her care. Called the insurance people to find out why. Turns out my SIL has "extra help" that should stay with her when she moved from state to state. However, I have discovered that for some reason PA did not close her records and the "crossover" for this extra help did not happen. Therefore they are taking out her "deductible" but with extra cares she should not have a deductible. I have tried several times to get this corrected, but am frustrated because I don't understand what they are telling me to do - I apparently do not know the correct words/people to talk to, to get the job done. Until it gets done, she is getting doctor bills that we have to pay. I tried going to Medicare (in one of my forays into the system) and was told I had to do this myself. Since I didn't understand the process, I called Medicaid (she has it) and asked for an appointment to come in to get help to get this resolved. I was curtly informed that they "don't do that". What advice do you have? She has such limited income that this takes more of a bite out of it than she (or we) can afford. It was explained to us at the beginning that when bills are generated, they go first to Medicare, then to any other insurance she might have, and finally what is left over goes to Medicaid. she should have NO bills - and before the transition from one state to another, she didn't have ANY bills.

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See my response.

When u get this all straightened out, you should be able to get reimbursed.
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Did u see my response to ur response to my post? If u understood that, you are good.😊

Like I responded, you may need to deal with the supplimental you signed her up for thru Medicaid. Ask them about her "special needs". Patrick's was automatic after he received SSD. I did nothing.
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pollinatorlady Nov 12, 2018
I guess I missed something in your reply. My SIL's special needs was also automatic. I was told it went with her wherever she moved, so it should have moved with her from PA to DE. It appeared to do that at first. But now we are receiving bills that should have been covered and I am being told that is why she got the bills. that the special needs was not applied in DE as it should have been. Also told that it was because PA did not close out her record, so DE isn't applying it. But no one I talked to anywhere said they could help me straighten out the record. I went and paid one of the bills today to keep it from going into collection. We can't keep doing this. Also, if it ever gets straightened out, my next question will be whether or how she can be reimbursed. I am not usually this "dumb", but the situation has me in near tears.
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Medicaid doesn't cross state lines. What one state does the other may not. The state she resides in should be the state who provides Medicaid. Is ur SIL disabled and very low income?

My nephew has a disability from birth. He receives SSD and gets extra help because of income. He is on Medicare as his primary and Medicaid as his secondary. He can only use doctors in the state where he resides and gets Medicaid. If he wants Medicaid to pay his doctors bills he has to use a medicaid doctor. And only a NJ doctor because that is where he lives. He can't go to DE to a doctor and the dr. bill NJ medicaid.

Here in NJ the Office of Aging handles Medicaid insurance questions. Check your County for where yours is. Usually the County seat. They maybe able to help you get this straightened out. Me personally, have to see what you are talking about.
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pollinatorlady Nov 11, 2018
I guess I didn't give a clear picture. My SIL has also been disabled since birth. The "extra help" is NOT from Medicaid - it is from Medicare. it was explained to me early on that this "extra help" DOES go with her from state to state. When PA closed their records for her, someone missed the step to have the "extra care" move over to DE. It seems from my recent conversations with Medicare that THEY don't do this. Medicare says they "do not" make appointments to solve such issues. my problem is that I can't find the correct source/sequence of phone calls to get this corrected. Until I do, she will continue to have a deductible and this results in her receiving bills. If they were not taking out her deductible there would be no bills.
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Your right Medicare gets billed first than Medicaid.
I am wondering what state is her Medicaid in. Is it the same state that her Dr is in that she is seeing, if not, than that might be why she is getting billed. Medicaid is different from state to state. Does her Dr participate with Medicaid? If not, that could be another reason.
If you are having a hard time trying to understand what the Medicare/Medicaid is telling you than call her Dr's office and ask to speak with their medical biller, that person can probably answer your questions better than anyone here. And they usually will break it down better to help you understand.

Just an idea.
Good luck.
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pollinatorlady Nov 11, 2018
Her Medicaid is in DE. Her doctor is in DE. the doctor is on her list of providers. Her doctor does participate in Medicaid. I did call the doctor's billing people, and all they could tell me was that their bill had been denied. The billing person said she has been doing this for 15 years, and knows nothing about cross overs. She just wants the bills paid. Oh, and the bill is for covered services. I just don't have a clue the proper person to get this taken care of. in the meantime, we don't want collections to happen, so we are paying it. Which brings to mind another question. if it ever gets resolved, will she be repaid?

oh, I just thought of something - need to look at the medicare papers again. I didn't notice but maybe there is an appeal process, and if I do that, the problem might finally go to the correct person to fix it. What do you think?
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