Author Topic: Louisiana Medicaid TPL claims  (Read 2064 times)

kbolt

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Louisiana Medicaid TPL claims
« on: September 26, 2008, 11:26:10 AM »
I have a patient that currently has BCBS and Medicaid. I cannot get the BCBS to pay b/c they want a United Healthcare eob. BUT the UHC policy is no longer in effect. The patient will not call to update her coordination of benefits file with BCBS. We cannot get our claims paid appropriately due to this. We have tried calling the patient and sending letters but there is no resposne. Another problem is Medicaid has never known that this patient has/had BCBS nor UHC so they want to pay as primary which is incorrect!

I would usually bill the patient but she has Medicaid which makes it totally different!

So can I bill the patient for this until she gets her files straight with all insurances or is that against Medicaid?



Any help or suggestions is greatly appreciated!

Kim

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Re: Louisiana Medicaid TPL claims
« Reply #1 on: September 27, 2008, 10:08:57 AM »
This happens a lot.. Most likely Medicaid doesn't know about BCBS... NOT NICE.. I would bill the patient anyway, they most likely KNOW of the situation. I've turned in a few patients for having other coverage and not alerting Medicaid. I pay taxes too.

Linda Walker
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Michele

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Re: Louisiana Medicaid TPL claims
« Reply #2 on: September 27, 2008, 04:54:12 PM »
This is a sticky situation.  In most cases you can't bill Medicaid patients.  In this case, I would send the patient a statement and indicate that BC will not make payment until they call and straighten out the UHC thing.  You technically aren't billing the patient, you are advising them they need to contact BC in order for payment to be made.  But maybe the reality of getting that request on a patient statement will 'jar' them into contacting BC.

Good luck!

Michele
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