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We are negotiating STBAS's subsidy, and have no idea which insurance plan to choose. There is one (Phoenix) that doesn't have one of his doctors in network, so that is out, but beyond knowing his providers are in-network, what is the difference between all the programs? I have looked at the websites for each, and read the manuals, and they all seem to be the same, so why are there so many different options??
And does anyone have experience with having private insurance as the primary on top of AHCCCS? How does that work? Do all the doctors have to be in-network for both plans? Does AHCCCS cover copays and dedicutibles for the private insurance like some on here are saying their Medicaid does?
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There really is no difference between the plans and what they cover. I picked mine by which one his current doctors take and the hospitals associated with it. My son will only be covered by AHCCCS but I have a friend who has a child covered by both. She has had issues with providers refusing to take her child with the private insurance only because they do not take AHCCCS. When my friend has tried to say fine, our insurance is primary so just bill them and we will pay co-pay they have refused saying it is "fraud". So, it has not really helped her at all. She has started not telling providers about the AHCCCS if she knows they do not take it and only gives the private insurance. It may be a local misunderstanding (she is in Tucson/Willcox area) but regardless providers refuse to take her daughter even though she has private coverage. I guess it could be that they are required to bill the secondary (AHCCCS) and just plain refuse to take anyone with any AHCCCS coverage at all so they do not have to bill or deal with the program at all.
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Thanks, phxmama. I'm still a little confused on how that works. If they don't take AHCCCS, then why is it a problem for them? They just bill the primary insurance and send a bill for the rest to the parents, no? I'd love to understand that more.Although I was envisioning the opposite problem of having doctors who take AHCCCS but not our primary, and then having to deal with all that mess. It looks like all his current doctors take at least one of the plans, and most are on our private insurance as well, so we might luck out.I still haven't figure out whether AHCCCS pays the private insurance's deductible and copays. That seems really weird to me, but I'll take it if that's the case!
I don't really understand it either but I think it is because if there is a secondary, AHCCCS, they are required to bill it and can not charge the parents. So if they don't take AHCCCS they don't take the the patient period. My employer only provides insurance for employees and the family plan is very, very expensive. I got my older son his own BC/BS policy years ago. Since the doctors we use take both Bridgeway and Phoenix Health plan I am fine with just AHCCCS. If you find someone who takes both, yes, your private will pay first and AHCCCS will cover the rest. Good luck---do you already know if you are approved for the subsidy? All subsidies come with AHCCCS.
Yes, we have been approved, it's just a matter of us signing the form. I have been trying to get them to be more specific about his issues and the necessary treatment, but they claim that "Developmental Disabilities" and the fact that his mom was on drugs is "enough" to cover his need for speech therapy and OT, and whatever sensory/LD diagnoses he may have in the future. Since our insurance only covers a limited number of therapy visits/year, I want to make sure the rest are covered by insurance, if they're not going to specify on the form that he can have as many visits as he needs. And then, of course, there's all the unknowns that will pop up later, as he's only 1.
I am glad to hear you are already approved. If he is already enrolled with DDD he should be fine and it will be nice to have the private for "extras" or non-AHCCCS providers. My son is with the behavioral health system through DBHS and I just went through another 3 hour intake process because they could not just change the name on his records they decided we needed to pretend he is a brand new client! Really??? Oh well at least all of his current services are re-authorized now and hopefully we are good to go. The really silly thing with behavioral health in my area is that if the kid does not have AHCCCS, the clinic will not see them and there is no private provider! So I absolutely needed to have him on the AHCCCS. I also got it based on parent's history of drugs and mental health issues.
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He is enrolled with DDD, although the clinic where he gets his therapies is telling me that they won't be taking DDD clients anymore. Except that his health insurance covers the therapies, so I'm not sure if that really affects us or not..... It's all very confusing.I can't believe they made you redo the intake! That's ludicrous. But if that's the worst that happens, then great! LOL