Medicaid Sticking Point: The "Other Insurance," aka Third Party Liability

Transitions can be difficult. For the most part, getting Medicaid is a wonderful thing, but occasionally there is a fly in the ointment. 

If you had medical coverage before, from an employer or the Marketplace, and that ended, you may need to let Medicaid know. The private insurance may have ended a while ago! But if Medicaid thinks that you still have that primary insurance, and you don't, you can have trouble getting access to your Medicaid health benefits. 

The trouble begins because Medicaid is always the insurance of last resort. That means, if you have private insurance that pays 80% of the bill, Medicaid will wait and pay the last 20% of the bill. This completely makes sense, unless. . . you don't actually have that private insurance, but Medicaid still thinks that you do. 

In that case, Medicaid's record of the phantom insurance means that Medicaid will not pay the hospital bill, because the phantom insurance has not paid the first part. 

Getting rid of the phantom insurance takes a little bit of elbow grease. The easiest way to remove the insurance is to call the MI Enrolls help line, (888)-367-6557. Choose the option for "other things," and explain that you have an insurance policy listed on your account that no longer is active. They will ask you for information about the insurance company, policy number, and the individuals listed. They will then send a confirmation request to the insurance company, confirming the end date for that coverage. This process generally takes about ten days, so don't wait until you are in the emergency room to get this problem fixed!

--R. Kraut

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