Seventeen Months Later

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Seventeen months ago, we celebrated the delivery of Benjamin’s shower chair. Last week I received an email from the equipment vendor. Apparently they didn’t get paid and said it was because we did not provide them with letters and a script from a doctor enrolled in NJ Medicaid.

Um, no.

When Benjamin turned 18 years old and received social security, Medicaid automatically came with it. For the first month, it was “straight Medicaid,” then we had to sign up for an HMO plan. The coverage is different between these two plans. Straight Medicaid covers shower chairs. The HMO plan does not.

We seem to confuse everyone in the insurance business because Benjamin also has medical coverage through my husband’s union. The union coverage is Benjamin’s primary insurance. Medicaid is secondary.

Through trial and error, I’ve discovered that nothing much changes on our end regarding medical claims. We have to follow the rules of the primary insurance. If they deny a claim, the secondary kicks in. Benjamin’s doctor takes our primary insurance and not NJ Medicaid. If he writes a script for medication or equipment and our primary insurance denies the claim, we are not required to make an appointment with a different doctor who is enrolled in Medicaid.

This happens all the time and the claims get paid.

Benjamin’s primary insurance denied coverage for the shower chair. Benjamin’s school worked directly with a Medicaid supervisor to approve this shower chair claim while we had the straight Medicaid insurance. I have all the correspondence to provide it, so payment should not have been an issue.

After several pre-8am back and forth emails with the equipment company, I realized they said the date of delivery was March 31, 2018 and they wanted to bill Benjamin’s current HMO Medicaid.

And that is when the less forgiving Brooklyn born and breed diva that lives deep within me lost it.

Benjamin did not have the HMO Medicaid coverage at the time of delivery on March 31, 2017. So I explained how billing an insurance company Benjamin didn’t have at the time of purchase would be an act of fraud, they responded:

“So we would do a pick up and re-delivery ticket with also re-submitting to HMO Medicaid for new authorization to get this paid.”

Um, double no.

I’m not going to pretend there was a pick up and re-delivery. That never happened. It’s fraud. From what I can figure out, the vendor simply didn’t file the claim within the required time frame allowed and now they can’t get paid.

So I asked the vendor’s representative if Medicaid would be cool with the whole fake pick up and re-delivery strategy.

And that was that.

With Benjamin’s school backing me up, I expect we’re done with this harassment dance.

Then again, I didn’t expect an email seventeen months after the shower chair was delivered.







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