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My mother in a nursing home received a bill from her primary dr that visits her in the nursing home for the balance after Medicare and Medicaid paid. We are in Florida. Are they able to do that? Have been calling Medicaid office but wait time is horrendous! Help please!

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Thank you for your help. I have called the doctor office 4 times and I have not received a returning call. All of you have confirmed what I thought, but I was beginning to think I might be wrong. Mom's pcp is a nursing home dr that does accept the assignment of Medicare and Medicaid.

I will just write the dr staff and hope that will be the end of it!!
Thank you so much for your answers. This is great to have a place we can ask for help!!
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Reply to Fibromema
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JoAnn29 Jun 5, 2019
If he excepts both, then he cannot bill u for any balances. Mom is on Medicaid because SHE HAS NO MONEY! No money, can't pay bills and family is not responsible.

I would write a letter Confidentially to the Doctor telling him that his billing office has not returned the 4 calls you made. That you feel the balance due is an error on billings part because Mom is now on Medicare/Medicaid. And since he is a participant, there should be no balance due.
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Fibro - so your mom is a resident on LTC Medicaid in NH & is being actively & regularly being seen by an outside MD who is not the MD, medical director, of the nursing home?

In my experience that is very unusual. For my mom & mil once they were residents of the NH, all health care oversight and decisions flowed thru the medical director of the NH. They wrote all orders for care often basing how things / scheduling are to be done depending on staffing. And RXs - written by medical director- got filled thru whatever 90/120 day blister pack script service the NH was contracted with. No outside docs inserting their directive / orders / prescriptions into the residents care plan as they wanted.

Unless there was something extraordinary going on, like specialized oncology care or they were recovering from surgery with post surgical care written into their admissions. My mom had the latter situation & it involved a eye RX x 3 daily for abt her first mo, they were aware before admission & ok for it, the medical director wrote the identical script as mom’s retinal doc., so all dispensed within their system. No outside RXs coming in to be dispensed.

Before too too much time goes on, I’d clearly speak with the DON (director of nursing, who imo is the goddess & power center for a NH) as to IF an outside MD care plan can at all work for how this facility runs. Then contact that MD to see if they accept Medicare & Medicaid. If not, they will bill your mom or you if you signed off to be financially responsible.

I’d bet, as others posted, her old doc will be viewed as “out of network” for care now that she is in a NH. Sometimes there’s a lag time in the insurer finding this out. But if so, insurance can clawback payments made. This can get ugly as they will bill mom/ you at full private pay rate. Really find out ASAP what is allowed for outside care directives.
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Reply to igloo572
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Just thinking...The doctors billing office may not realize they cannot bill you. I have had this happen with a Dr office billing Medicare. Right on the Medicare statement it said Dr. has excepted amt paid. When I showed this to the billing clerk, the amt was taken off.

Medicaid does not send out statements, they just pay the balance.

I think ur going to find is Moms PCP does not except Medicaid.
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Reply to JoAnn29
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JoAnn is right and I think it's the same in every state, if the doctor accepts Medicare and Medicaid and your mother has both coverage they shouldn't be able to bill you the balance. That's part of the deal the doctor agrees to accept Medicare's rate for service.
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Reply to Lymie61
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Usually when you have Medicare and Medicaid you owe nothing. The problem is...does this doctor except Medicaid. If he does, he can't bill for a balance. If he doesn't then he can. As I understand it though, a nonMedicaid doctor is not allowed to bill a medicaid reciprient. You may have to go with the NH doctor.
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Reply to JoAnn29
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Faerieflies is correct. Also Medicare doesn’t cover everything so your mother could have had services done such as lab work that Medicare doesn’t cover. But when that happens, like faerieflies said, the doctor tells the patient upfront that they will have to pay out of pocket. When this happened to my MIL, she had labwork done and ONE test was not covered by Medicare at all. So Medicare approved a payment of the services they did cover and the doctor then sent MIL a bill showing what Medicare paid and what she owed (she owed the full amount of the test that wasn’t covered).
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Reply to worriedinCali
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If the doctor accepts Medicare....and if the item(s) billed for are approved item(s) by Medicare...then Medicare pays first and Medicaid covers all the rest.

but...if the item(s) were not approved by Medicare, then the patient must pay for it out of pocket.

for example....if a patient is given a medication in the ER that is actually an over the counter drug (like ordinary aspirin), the patient will be billed for it cause Medicare doesn’t approve it.

but...if Medicare paid their share, then that means that Medicare approved the bill. Secondary insurance (in this case Medicaid) covers the rest. The doctor is not allowed to bill the patient unless Medicare doesn’t approve the bill...in which case Medicare would have paid no part of it. When a doctor accepts Medicare/Medicaid.....it means he accepts their payment as payment in full.
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Reply to Katiekate
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I think they can do that if the doctor is "out of network" and if they are in network and he did things for her or provided for her that are not covered by her plan. Most doctors will tell you ahead of time when there are going to be bills that you will have to pay out of pocket.
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Reply to faeriefiles
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