Friday, September 28, 2012

Medical Assistance Copayments

On September 21, 2012, the Pennsylvania Department of Public Welfare sent letters to families receiving Medical Assistance for children with special needs. In true DPW style, the letter was nearly impossible to decode.

First, a full page devoted to reassuring us that our benefits "have not changed" except that things that used to be free would now, in fact, not be free. The bottom of page one includes the name and address of free legal help. These letters do tend to make one ready to file a lawsuit pretty quick. I gathered by page three that our family would now be responsible for 5% of our monthly income in copays because our income is at least 200% of the poverty level. To me it read like an annual copay responsibility (not too bad) so I breezed through to the end, several pages of the appeal procedure and a delightfully friendly "Welcome to Medical Assistance" page.

I showed the letter to Tim. His engineering brain led him to scrutinize the document closely. According to him it was 5% of our income per month, but a table suggested each service would have a copay amount assigned to it. For instance, a service that bills $100-200 to Medical Assistance would charge our family a $20 copay unless we'd hit that 5% limit.

Some services were listed as exempt from copays: family planning, emergency services, laboratory services, tobacco cessation, oxygen. Twenty-one exempt items in all. No where did either of us see how much hearing aids would now cost us.

We're not ready for new hearing aids. We're nine months away from even getting new ear molds, but I don't like to be surprised. I called the 800# listed because I had questions.

You'll find at least three different 800 numbers throughout the twelve page packet. I picked one, and of course a long message indicated that next time I should call a different number. Five minutes later and two many button presses to count, I had a human person on the line. She informed me that I needed to call UPMC as they are the actual health plan. DPW isn't mandating how the copays are to be collected, she said.

So why the table? The exclusions? She certainly couldn't answer those questions.

UPMC was much quicker to answer my call. I only had to press #1 for English once and it was a much shorter wait time. Here I got good news. UPMC is not charging copays for children. They're advising everyone to disregard the behemoth, rather upsetting letter from the state.

As far as other health plans, my UPMC friend doesn't know. Each family will need to contact their own provider to find out the real deal with these copays.

This revelation leaves more questions than answers. Are the providers just going to be shorted on each service? Are less providers going to accept Medical Assistance because of these changes? If this is really variable between health plans will my child's doctor know what to charge us?

For now, it's good news in our house. Still, after November 1st I'm going to get a little thrill when I present Julia's health insurance card. Not the good kind either.

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