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DaveiDburg Asked October 2014

I live in PA and doctors outside of the state will not take Medicaid, what can I do to see a specialist out of state?

On medicare and medicaid, but need a specialist who works outside Pennsylvania and does not accept the insurance. What options do I have to get the coverage I need to see the right doctor?

samara Oct 2014
Well yes of course, I am assuming that the out of state doctor or facility has encouraged you to explore getting the PA, so that they can make an appt for you. That is an essential part of the equation.

twopupsmom Oct 2014
getting prior approval will not get that specialist to accept you, his rules are his rules, can't blame the doctors, surely you can find one in PA that's the same equivalent of the out of state Dr.

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samara Oct 2014
I used to work for a major hospital accounts department. The process is.different for each state's Medicaid. You will.need to have your state's Medicaid involved, getting a Prior Authorization, and the other state facility/doctor will have to accept (or.negotiate) a reimbursement rate before services rendered. If you go ahead and try to get services it would be a big headache. Get PA in advance!

pamstegma Oct 2014
True, Medicaid is run state by state. So ask your MD to refer you to the same specialist within your state.

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