Author Topic: Fighting with Patient in NY, who is right??  (Read 1649 times)

JTL713

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Fighting with Patient in NY, who is right??
« on: March 15, 2013, 04:39:32 PM »
Here is the story - I work in a doctors office, and in the mid fall of last year, we saw a patient who came in with a Medicaid HMO card. We took that plan, but not straight Medicaid, so we saw the patient. The girl who runs eligibility in our office clearly never called the Medicaid HMO, because it turns out the patient had term'd with the Medicaid HMO about 2 weeks before the procedure was done, and only had straight Medicaid. So we did a procedure on this woman when she was a straight Medicaid patient, unbeknownst to us (or her, she didn't know the HMO was term-ing before the surgery). We don't take straight Medicaid, and the doctor I work for wants to bill her, as we didn't know she had straight Medicaid only. I spoke to the patient who stated it's not legal in NY to bill a Medicaid patient. Are we just out of luck or can we go after her? All the reading I've been doing on it doesn't seem totally clear......
Thanks so much for your help!

supertaz93

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Re: Fighting with Patient in NY, who is right??
« Reply #1 on: March 15, 2013, 05:51:05 PM »
Just curious, are you sure when the girl checked status that she was not eligible and then after that date Medicaid updated their eligibility?  Does she have a printscreen or confirmation number?  Now saying that I am not in NY and I don't know anything about NY Medicaid.  If she is on Medicaid you probably aren't going to get any money out of her and will just end up turning the account to collections (if you can even bill her) which these days doesn't do much but get it off your books.  If you have proof that they were eligible at the time of service, I would try appealing this and see if you can't get them to pay.  Explain the situation, that you wouldn't have seen the patient if you were given the right information and so forth.

JTL713

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Re: Fighting with Patient in NY, who is right??
« Reply #2 on: March 15, 2013, 06:16:08 PM »
Thanks for the reply! She THOUGHT she had a Medicaid HMO at the time of the surgery, but it turns out that that had tem'd before the surgery, and her straight Medicaid was terming a few weeks after the surgery, making her a straight medicaid person at the time of her surgery. The person who does eligibility in my office messed up big time, they never checked the term date with her medicaid HMO - if we knew it had term'd we would have called her and cancelled. I'm pretty sure in NY we are screwed, but if someone could point out a specific law one way or the other that would be appreciated!!