I also have a Medicaid problem. Here in Mass. as far as I can tell, some
Moms simply have Medicaid, and some start out with Medicaid, then get
signed up for HMOs along the way. Sometimes Moms choose the HMOs, sometimes
they have no idea they're being signed up.
For me the problem arises because Medicaid OKs the pump for the NICU baby
for, say, 3 months, but after 1 month Mom's coverage has changed. Most HMOs
here (except Blue Cross who only pay for premies born before 32 weeks) do
cover the pump. But since I am not a provider for them, I don't get paid.
Nor do I get paid by Medicaid because this is no longer their business. So
I am supposed to go to a premie Mom and tell her to get a new pump through
a different company? Most of the time I end up subsidizing the rental..
However one by one I have been tackling the HMOs and applying, if not to
become a provider, at least to be paid for the remainder of the rental.
THIS IS A LONG SLOW PAINFUL PROCESS! But so far I have persuaded one new
HMO to cover rental pumps not only for NICU babies but also for working
Moms! So it is an interesting challenge and certainly an investment in the
future of not only my business, but of breastfeeding
recognition/reimbursement.
The Medicaid regulations are vast and complex but I think (??) that if a
Mom rents from an enormous DME (durable medical equipment) co. that
provides for both the HMO and Medicaid, the rejection of the coverage from
the HMO then allows the provider to re-apply to Medicaid and get coverage
after all. It just has to be the right kind of rejection: ie it must say
'we do not cover breastpumps'; not 'we won't pay this provider because they
don't work for us'.
Clear as mud, as my grandma used to say
Anne Merewood