Autism Waiver and private services

[Anonymous]

It looks like we are going to be approved for the Autism Waiver and I read on a FB group that you need to be careful about your private providers because if they don’t take Medicaid they can’t bill your insurance. Is that true??

We have BCBS and a private therapist (mental health) who takes our insurance and a psychiatrist who is out of network but bills our insurance (for minimal coverage but still).

Our DC has finally found a good fit with both and there is NO WAY we want to discontinue with either so I’m sort of freaking out.

We have been on the waiver wait list for 8+ years so this is a big deal but our DC has made a lot of progress with this therapist (and we work with a parent coach in the same practice) and we cannot afford to give them up.

[Anonymous]

My child has Medicaid through Katie Beckett as secondary insurance (similar to autism waiver) in and that is not the case at all. Therapies go through primary insurance first and then to your secondary (Medicaid). Some providers will do this for you and others will have you do this yourself. Medicaid only covers services that are preauthorized and approved so it may not cover everything, but is good to have if you can get it.

[Anonymous]

Anonymous wrote:My child has Medicaid through Katie Beckett as secondary insurance (similar to autism waiver) in and that is not the case at all. Therapies go through primary insurance first and then to your secondary (Medicaid). Some providers will do this for you and others will have you do this yourself. Medicaid only covers services that are preauthorized and approved so it may not cover everything, but is good to have if you can get it.

This assumes the providers take insurance which many do not. Correct? We’ve been contemplating Katie Beckett but think it may not be worth it since all our providers don’t take any insurance. How does Medicaid work for out of network people?

[Anonymous]

Don't assume you have the waiver until after it's approved.

[Anonymous]

Anonymous wrote:My child has Medicaid through Katie Beckett as secondary insurance (similar to autism waiver) in and that is not the case at all. Therapies go through primary insurance first and then to your secondary (Medicaid). Some providers will do this for you and others will have you do this yourself. Medicaid only covers services that are preauthorized and approved so it may not cover everything, but is good to have if you can get it.

This is the consensus from everyone I've talked to, including the Autism Waiver person and my insurance company (who I called after I posted this.) The provider is insisting that they will no longer be able to see our child (or we will need to pay out of pocket) if they are approved because our private insurance will say they won't pay because our DC has Medicaid, and Medicaid won't pay because they don't accept Medicaid. I really don't understand where they're coming from.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My child has Medicaid through Katie Beckett as secondary insurance (similar to autism waiver) in and that is not the case at all. Therapies go through primary insurance first and then to your secondary (Medicaid). Some providers will do this for you and others will have you do this yourself. Medicaid only covers services that are preauthorized and approved so it may not cover everything, but is good to have if you can get it.

This assumes the providers take insurance which many do not. Correct? We’ve been contemplating Katie Beckett but think it may not be worth it since all our providers don’t take any insurance. How does Medicaid work for out of network people?

Not necessarily. We have multiple therapists. Only one takes insurance anymore. For the others, I have to pay out of pocket, then submit to primary insurance. I can only submit to Medicaid once I have an EOB from the primary provider. When the primary covers the entire cost, I do not need to submit anything to Medicaid.


For the provider that takes insurance, my child has a Medicaid authorization for those services. This provider submits the bills to our primary insurance, I send back any EOB or payment and then the provider submits to Medicaid and is reimbursed the remaining amount.


One of our therapists previously took primary insurance and they would submit it to our initial insurance and then I would submit to Medicaid.

Your primary insurance should not deny coverage because you have Medicaid as a secondary. That's just not how it works in my experience.