Medicaid managed care Puns

How do you all understand how Medi-Medi plans pay. I understand it generally to mean that Medicare allows a certain amount and pays 80% of it, and then the remaining 20% goes to the patient or supplementary insurance if applicable. In my experience, Medi-cal/Medicaid has paid the remaining 20%; however, this Gold Coast plan is refusing to cover the remaining 20%. All of the billing is Inpatient E&M bread and butter doctor visits (99223, 99233, so on and so forth), and after a 3rd round of claims submissions I am still stuck with these denials (X62). Their rationale is that since Medicare paid in excess of what they allow as a primary claims submission they are not obligated to pay the remaining 20% in any amount. Can anyone shine some light on whatever mistake I am making, or give me some advice in where I need to go from here.

My mom has been on straight Medicaid for about 2 years. Recently a family friend with a lot of Medicaid experience suggested that Medicaid under a plan is better than straight Medicaid and so we signed her up for empire blue cross (were in NY). She’s been seeing an opthamologist and had an eye procedure in January. Since then we’ve received the empire card. This week we went back to the doctor for a follow up but they’re saying they don’t accept managed care plans! Did we make a mistake to get under a managed care plan? Was straight Medicaid a better option?

So several of our medicaid customers came in today with letters from Optumrx stating they would no longer be able to use our store starting December 1st, and they could go to the chain store ten blocks away. So I started attempting to call Optum's contracting department (got message saying they were closed, called back, put on hold ten minutes, transferred to voice mail, "this mailbox is full, you cannot leave a message at this time"). So I sent them an email and figured I'd try again 9AM Monday. However, a call to our buying group gave us the answer - Optum was dropping most independents from the medicaid network, no chance to sign a contract at any rate. I got the email back from Optum which stated -

"Greetings,

The Value Network is a closed, narrow network that is currently at capacity for pharmacy participation. As a result of this change, your pharmacy will not be participating in OptumRx’s limited network.

I apologize for any inconvenience this may cause. The network the plan chose is a limited network with fewer pharmacies than our broad network. By its nature, a limited network has fewer pharmacies and therefore some pharmacies have to be excluded. If the client requirements change in the future, your pharmacy may be considered for participation. At this time we are not considering any new pharmacies for participation. "

Oh, and we also found out that the stores that were "lucky" enough to be in the network will be getting reimbursed at AWP -22% on brands.

I'm sure we'll be seeing more of this going forward.

Hello Reddit! This is my first time posting so I apologize in advance for any errors.

I came out to my father a few days ago (he was very supportive! ^^) and I'm eager to start my long journey of transition (mtf btw). However, as an egg, my long days of being an unmotivated NEET has made me rather oblivious to how stuff works in the real world.

I currently live in New York City, Manhattan and I'm looking for a way to have transition related costs covered by Medicaid, especially the surgery. I looked at this and it does seem like it is possible, however, I'm currently enrolled for Healthfirst Medicaid Managed Care and I see no mention of transgender stuff in their benefit list.

I currently have one of these and one of these (My blue Medicaid card does not have photo and signature for some reason).

So my main questions are:

1. Would I be ok staying with Healthfirst or if I should switch to another company?

2. If I do switch, what company should I switch to?

3. Is there anything I would have to do before switching insurance?

4. Is there something I'm overlooking?

Thanks for reading!

I qualify for Medicaid Managed Care in New York City, and they give me like 10 options for providers and absolutely no information about how I would go about choosing them. I need one affiliated with Mount Sinai. Help?