Poll

non participating provider... medicaid seondary.. can he balance bill me?

true
1 (16.7%)
false
5 (83.3%)

Total Members Voted: 6

Author Topic: Medicaid  (Read 4259 times)

lilfufu85

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Medicaid
« on: July 25, 2010, 02:32:59 PM »
I'm not sure if this is the right web site to be on, but i can not find a straight forward answere and i would like to sound like i know what i am talking about when i go to my doctors office. So here i go ... I have excellus blue cross for my primary insurance through my employer with a high deductible.. i picked up medicaid secondary through pcap and because i have a primary insurance i can not choose a managed care program i need to stay with the striaght medicaid. whis my provider that i am going to does not accept. I have recently been told that becuase my provider did not have me sign a waiver that he can not legally balance bill me for anything because i have medicaid.. is this true?!
I really like the provider that i am seeing.. his care is great i just dont want to be stuck with any bills if i can get out of it. but at the same time i dont want to upset him either ..
This is from new york state.. that will probably make a difference
« Last Edit: July 25, 2010, 02:35:49 PM by lilfufu85 »

Priyan

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Re: Medicaid
« Reply #1 on: July 26, 2010, 01:13:59 AM »
Understanding your situation. I realise now, and am surprised that you are getting an Bill.

When your primary insruance process for deductible. your secondary insurance Medicaid will pay for it.

you mean to say the Dr whom you visit is not a part of Medicaid. (Dose he not enrolled with NY Medicaid)

Priyan.D
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Alice Scott

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Re: Medicaid
« Reply #2 on: July 26, 2010, 04:27:55 AM »
You are basically asking your doctor to pay your deductible for you because someone on his staff forgot to have you sign a waiver.  Do you think he will mind paying your bills for you?
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PMRNC

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Re: Medicaid
« Reply #3 on: July 26, 2010, 10:27:17 AM »
What waiver? Sounds like Medicaid told you or the provider told you he was not a NY Medicaid Provider, Why wouldn't you then be responsible for out of pocket expenses..(deductibles)?
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Michele

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Re: Medicaid
« Reply #4 on: July 27, 2010, 05:50:48 AM »
I thought in NYS, if the patient has Medicaid (primary or secondary) and the provider knows they have Medicaid, if the provider is not a Medicaid provider that they are not supposed to treat the patient.  In this case, the provider would have to refer the patient to another physician who does accept medicaid.  I was told long ago, and am admitting that I am not sure if this is still the case, that it is illegal to bill any patient who is eligible for medicaid.  ??
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PMRNC

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Re: Medicaid
« Reply #5 on: July 27, 2010, 09:57:28 AM »
Michelle, I heard the same thing..but when I called Medicaid, they told me that would only be if the patient had Medicaid Primary..If they have a medicaid managed care plan (either primary or secondary) it is up to them to go to an in network provider.  I very rarely have this come up, and my clients (all but one) accepts Medicaid (FOR NOW) I could never find documentation of that either anywhere. But we also don't know this person is in NY

 
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Michele

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Re: Medicaid
« Reply #6 on: July 27, 2010, 02:40:41 PM »
Actually, we called today too to verify.  THey told me that if the patient is informed up front, the provider and patient mutually agree, then they can be charged for services not covered.  They recommended that the provider have the agreement in writing signed and put in the patient's chart.

Learn something new every day!   ;D
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PMRNC

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Re: Medicaid
« Reply #7 on: July 27, 2010, 02:50:33 PM »
Michelle, right that's what they told me but then I asked where I can view that and they had no clue, they passed me on to another rep who told me that's it's just an advisement.. so when I said.. ok then if we don't have an agreement we can bill the patient and she said "Well I guess technically you can".  ??? :o
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dekenn

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Re: Medicaid
« Reply #8 on: August 10, 2010, 11:44:36 AM »
Here's another one of those secondary questions.. Sorry, I seem to have a lot of them lately   :)

We have a patient that had surgery, 4 separate procedures.
Medicare is her primary, and they allowed and paid their portion for all 4 procedures.
Horizon NJ Health (managed medicaid program) is her secondary... According to their policy, they pay 100% of first procedure, 50% of second procedure and 25% of third procedure. No other procedures will be paid. period. doesn't matter if it was processed by medicare and that it's a legitimate bill.
So, they only covered half of what medicare said was patient responsibility for the 3rd procedure and none for the 4th.
Can I bill the patient????   ???

PMRNC

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Re: Medicaid
« Reply #9 on: August 10, 2010, 05:11:12 PM »
What does the 2ndary say for patient responsibility? I'm thinking in this instance you can bill patient up to the patient balance portion from the Medicare EOB.
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Anand

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Re: Medicaid
« Reply #10 on: August 11, 2010, 01:18:41 AM »
Here's another one of those secondary questions.. Sorry, I seem to have a lot of them lately   :)

We have a patient that had surgery, 4 separate procedures.
Medicare is her primary, and they allowed and paid their portion for all 4 procedures.
Horizon NJ Health (managed medicaid program) is her secondary... According to their policy, they pay 100% of first procedure, 50% of second procedure and 25% of third procedure. No other procedures will be paid. period. doesn't matter if it was processed by medicare and that it's a legitimate bill.
So, they only covered half of what medicare said was patient responsibility for the 3rd procedure and none for the 4th.
Can I bill the patient????   ???
If that's what the pt's plan say, i think pt can be billed.