Hello! The new eligibility responses in MMIS show patients having Standard and Limited on the same day. I thought it could be a pregnant patient, but that is not the case. Any reason it is showing like this? Is this correct, patients now can have both eligibilities? How can that be? and should we be […]
I have a client over 65, She has Medicare A&B with the Senior Buy In. She has no problem getting the coinsurance and deduct paid by her Mass doctors. However, she goes to a doctor in Rhode Island, 3 times a year. They always bill her the balance after Medicare. Her Medicare summary clearly […]
If a client has a $3,000 esi deductible and a $1,200 deductible for partial HSN do they need to pay both deductibles before their HSN eligibility begins? Mr. Smith has a $9,000 procedure and pays his $3,000 deductible. Now he has full coverage from his esi. Is the $1,200 partial HSN deductible considered payed too? […]
Hi, I have a client who just turned 65 and enrolled in Medicare. He was previously on MassHealth CarePlus. The CarePlus followed him as a secondary to his Medicare. The client emailed me that he went for a doctor’s appointment and his specialist told him his MassHealth is inactive. I called an spoke with a […]
Hi fellow Navigators, My name is Buliah Mae, Lead Navigator for the Hilltown Community Health Centers. Our three-person team is currently considering new ways to track our monthly report data and are interested in how other health centers do this. What are the pros and cons? Is the program web based? Is the program customized […]
Happy 2022 everyone. I have a question regarding a client who is 62 years of age who wants to apply for CommonHealth. Her spouse is 66 years of age. Here are some facts: The couple have an active application via the Health Connector. Both are currently enrolled in a CC plan. The wife has Medicare […]
Hello We have had luck changing patients who are locked into their plans by explaining that they have been our patients for a long period of time and this is used as the “exception”. Recently, patients who move and are assigned a plan close to their new homes are not being changed back to their […]
Hello, Now that we are in OE, there is a bit more urgency to having verification documents processed. We have noticed that some documents uploaded in Sept/Oct are still outstanding. Cases have been created to process them more quickly, but even that isn’t happening. Does anyone have insight on what is happening behind the scenes […]
I have 2 members searching the “Health Connector” coverage for help paying with IVF. I am having a hard time locating a plan or benefits. Does anyone know of a plan? Member 1 – Has MassHealth but since they will not cover IVF would like to purchase a “Health Connector” plan and are okay with […]
We got a call from a grandparent whose child passed away very recently leaving 3 children of their own, and all 4 members of the family were (well, are currently) on MH Standard. The deceased person is the HOH on the application and there are no other adults. The grandparent has 90 day guardianship of […]