Billing > Billing

Medicaid as Secondary

(1/6) > >>

I work at a Dermatologist office. We are not contracted with Medicaid. We have been told if we are contracted with Cigna (or any other insurance) and the pt has Medicaid as the secondary we can not turn them away. We have been billing CIGNA, then they apply the a certain amount to their deductible. Since we are not contracted with Medicaid we can not bill Medicaid. We have been writing off any amount due. Is this what we should be doing? Can we bill the patient for the copay, deductible and coinsurance from their primary insurance since they do know we are not contracted with Medicaid?

Does anyone know the contact information of someone who can answer this question for me?

Generally, if a doctor is not contracted with Medicaid, s/he cannot bill the patient for anything.

More specifically, even if a doctor is contracted with Medicaid, s/he maybe cannot bill the patient for anything.  The logic is that, if a patient can afford to pay their co-pay and deductible, they most likely would not qualify for Medicaid.  The patient has Medicaid only because they cannot afford the co-pay and deductible.  The Medicaid no-bill rule reflects this reality.

Medicaid is a State administered program, and the rules are bound to vary somewhat from state to state.  Also, Medicaid has a number of different programs within a given state.  Bottom line, you would need to check with the patient's specific Medicaid plan to see what options you have, if any.

Finally, if you are contracted with Cigna, my understanding is that you cannot turn any Cigna patients away, Medicaid or not.  That is the point of being contracted with Cigna: you promise to accept Cigna patients.  The only way around this would be if your doctor was not taking on any new patients at all.  But again, that depends on the specifics of your doctor's contract with Cigna.

Scenario 1: Patient has Cigna as Primary and Medicaid as Secondary

If the provider is not contracted with Medicaid, then the provider can bill the patient.

If the provider is contracted with Medicaid then they cannot bill the patient.

To verify this statement, it is best to call your Medicaid State contractor. 

Hope this helps.

It always amazes me the amount of patients that come in with a group policy as  primary and Medicaid as secondary.. <sigh>  Interesting enough some states whether you par or not won't let you bill the patient if they have Medicaid, however I have a provider who's patient did NOT disclose his Medicaid secondary until he got the bill after his primary paid. Myself and my client did not back down and we were within our legal rights to bill the patient. Yes you should call your local Medicaid first. 

It always amazes me the amount of patients that come in with a group policy as  primary and Medicaid as secondary.. <sigh>

Linda, I'm curious what you mean by that statement, particularly the <sigh>.  Given that Medicaid is means-tested (and assuming the state worker did the appropriate means test before granting Medicaid status to patient), Medicaid would be provided by the state as secondary because the patient demonstrated that paying the co-pay and deductible would be a hardship, or would be impossible.  As wages fall and the cost of health insurance rises, I expect there will be many more folks coming online with Medicaid as secondary.

For doctors who are Medicaid providers, Medicaid will pay the co-pays and deductibles due on the primary insurance.  For doctors who are not Medicaid providers, Medicaid will not pay the co-pays and deductibles due on the primary insurance.  In either case, Medicare can rule that you cannot bill the patient - depending on the state, and the particular Medicaid program the patient is participating in.

To split hairs - you and your client may have been within your legal right to bill the patient, but you may not be within your legal right to force him to pay (e.g., sending him to collections) if he was covered by Medicaid on the date of service .  The distinction being, patient may pay, but Medicaid may have the right to require you to refund the money.  But again, the specifics of what is allowable will depend on what state the patient is enrolled in Medicaid in and the specifics of his particular Medicaid program within that state.

We ask our clients' staff to always ask the patient if they have a secondary.  But they don't always remember to do this.  So we also sometimes end up with situations such as what you described.  When we are informed that the patient has Mediciad as secondary, we simply write off what we billed them for (that is our agreement with our clients) and move on.


[0] Message Index

[#] Next page

Go to full version