Author Topic: Does secondary Medicad pay for primary deductibles and copays?  (Read 70 times)

Lesa

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We are Psychiatric group (4 MD's) & we have hired a new biller that states if a pt has a commercial insurance as primary & Georgia Medicad as a secondary that you CAN collect deductibles and copays from the patient the day of the appointment. Is that true? We are in network with both. We just started taking GA Medicad so I am not the experienced with Medicad but I was always told you can not collect anything from a Medicaid pt.No missed appointment fees, etc..

Example... BCBS pt with a $6000 deductible that had not been met, Medicad as a secondary, and the biller told the pt she owed $300 for the visit since she hadn't met her deductible and " GA Medicaid doesn't pick up deductibles or copays"
Can someone please help me? I have exhausted all avenues trying to find the answer to this question.  It is literally tearing our office apart.

P.S. if you can NOT collect commercial deductibles  & Medicad doesn't pick up commercial copays and deductibles how can doctors possibly stay in business?
Thanks for any help

Michele

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Re: Does secondary Medicad pay for primary deductibles and copays?
« Reply #1 on: October 30, 2017, 07:31:29 AM »
answered on other post:

That definitely does not sound right to me.  I know for sure in NY you CANNOT bill a patient who is Medicaid eligible.  I'm not sure specifically with GA however, if the primary applied to the deductible and you are billing GA Medicaid as secondary then they will be paying so why would you collect from the patient before knowing what the secondary is going to do?  All of the Medicaids I am familiar with do not have a deductible so they will be making payment and since you are participating with Medicaid you have to accept their allowed amount so collecting from the patient before billing Medicaid will cause a financial nightmare.  And IF the patient did pay (which if they most likely cannot shell out that kind of money because if they could they wouldn't be Medicaid eligible!) there are going to be refunds galore!

Medicaid usually pays if secondary when the primary applies to the deductible.  They only pay up to their allowable, but they pay.  In NY they also pay copays.  From a quick search I see that GA Medicaid covers the Medicare deductible so it should also cover a commercial insurance deductible as well.

Does your biller think that Medicaid is not going to cover these and if so, why?

The whole thing just doesn't sound right to me at all.  Without knowing your biller's side it's hard to give a fair judgement but it sounds very strange. 

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