Ah, they don't tell you the truth. That's the way it is in the real world.
Our insurance company would never tell us this. In fact, I'm sure they would flatly deny this happens if asked.
But I could round up more than a handful of families with kids of all different diagnoses--from CP to Autism--and give you the bad news in person.
It sucks!
Every financial jurisdiction (county, township, etc) has what is called a CCB--Community Centered Board. The CCB is responsible for arranging services, disbursing funds, and providing family support in general. Our CCB covers 3 counties...
They usually have a few different arms--before 3, juvenile, and adult. I was warned when she was 18 mos that this might happen and was advised to take advantage of all the laws that exist for kids 5 and under. We did.
Every day that we have coverage under both arms, we are fortunate. Private insurance always takes precedence over Medicaid in billing, so Medicaid isn't hit first.
Don't feel bad about this, Mer. This is something that you as a company entering a contract with an insurance company cannot control. Just because your company provides the coverage does not mean that they have to provide it to those who can access coverage elsewhere. It reduces profit by paying out for people who have more medical problems that are not injury related but congenital.
Sad but true.
It may not be true in your state if you have laws that prevent insurers from doing this. Our state does not have an insurance commission, so anything goes. Yours might--and they just might have a law that states that all insurers must provide to everyone.
So take heart--your state just might be a little kinder to those who can't make it on their own.
"There are only 2 ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle."
