Patient with BCBS and medicaid

[LYNNDYLOO1974]

Hi guys,

This is my first post. If I come across as dumb bear in mind Im a British citizen living in NC trying to navigate around a system that blows my mind!

I have a new patient (Chiropractic Office) that presented a BCBS insurance card and a medicaid card.
Which insurance should I file? I thought the BCBS would be primary? Why would someone have a private insurance and a medicaid one? Aren't they for people that cannot afford private insurance?
Im confused!!

Thank you

Lynn

[Michele]

BC would definitely be primary to Medicaid.  Sometimes a patient will have both although it is not common.  For example, a child with a disability may qualify for Medicaid due to the disability, but the parents work and they have insurance through their employer that covers the child as well. 

[BrendaAnderson]

Basically, medicaid provides health insurance to people who are poor, have certain serious physical and mental health conditions, and to elderly people in nursing homes. In every state, Medicaid covers essential healthcare services whereas BCBS offers some benefits like no application fee, fast issuance of the patient's policy. One of my friends was telling me about The Health Exchange Agency who offers bcbs Medigap plan (https://www.thehealthexchangeagency.com/blue-cross-blue-shield-medicare-supplement/) to the people who are not able to pay the bills of hospitals.

[CIA_2019]

I am sorry. I've been dealing with Medicaid all day. I meant the patient has Medicare. However, BCBS says they will not pay until Medicare gived a denial. However, Medicare will not give a denial because they do not cover the service.... How would I get BCBS to pay?

[cflorez]

Medicare will provide an EOB. It will be a denied EOB. Then you can bill BXBS. However, if Medicare states that they do not have Insurance for that patient. Then the patient needs to contact Medicare and do a COB. Coordination of benefits. Once that is straightened out, then you can bill BXBS as primary.

[Michele]

Sometimes all you need is the GY modifier which indicates it is not a Medicare covered service.