Follow
Share

Why do I have to pay that?

Find Care & Housing
The answer to your question depends, in part, on the type of Medicaid assistance you are receiving and the state in which you reside.
Are you receiving "Community Medicaid" or are you participating in a "Medicare Savings Program".
If, for instance, you are participating in the Qualified Medicare Beneficiary ("QMB") Medicare Savings Program, then Medicare providers are prohibited by Federal Law to charge the patient anything above Medicare's reimbursement and the state's Medicaid payment (if any) irrespective as to whether or not the provider participates in a given state's Medicaid program.
Background can be found here: www.ssa.gov/OP_Home/ssact/title19/1902.htm
But you may be better off calling Medicare (1-800-MEDICARE) to discuss your particular circumstances or search the Medicare.gov website for more information.
Helpful Answer (3)
Reply to Ralph Robbins
Report

On community Medicaid you have to be referred to doctors who accept both Medicare and Medicaid. Otherwise, you will still be responsible for co-pays. It is a patient’s responsibility to make sure that the doctors they go to accept both Medicare and Medicaid.
Helpful Answer (15)
Reply to anonymous439773
Report

I suppose that either
A) the clinic does not have the Medicaid coverage on file. They don't know you have it. OR
B) they don't accept Medicaid, which is their option

If you did inform them of your Medicaid coverage, they should have told you immediately that they don't accept it, if that is the case.
Helpful Answer (14)
Reply to jeannegibbs
Report

To the best of my limited knowledge, you shouldn’t have to pay anything. People go on Medicaid because they have no money and can’t afford to pay, right? Call the billing department of these doctors who are sending you the bills and ask them why you are getting bills. When my mom had an $800 bill from her dentist, I told them she was on Medicaid, but they said they don’t accept Medicaid. Well, Mom didn’t have the $800 so basically the dentist got stuck. The only thing I can think of is some sort of silly deductible.

Keep a pen and paper handy and make notes of who you speak to at the billing department and what they say. Make sure they have all your information correct. We hit a glitch once when someone entered my husband’s wrong birthdate.
Helpful Answer (6)
Reply to Ahmijoy
Report

If you decide to switch to an integrated Medicare/Medicaid plan be sure to check  and see if their drug formularies have your medications included. You will still have to check to make sure your doctors are providers to the integrated plan. There could be some unpleasant surprises if the plan is not an approved provider. No provider has to accept Medicaid and Medicare.
Helpful Answer (4)
Reply to anonymous439773
Report

If you need more help try the County Office on Aging. I live in Riverside County, California and they have a special program to help you with the process.
Helpful Answer (4)
Reply to MaryKathleen
Report

I had to contact the medical billing office and my dad's integrated Medicare-Medicaid provider (Humana) many times for bills my father received.  Often it was a case of a billing error, either at the doctor's office or with Medicaid, or Medicaid was being very slow to pay.

Do they offer integrated Medciare-Medicaid plan options in your area? If you were to change to the integrated, it could help to get bills resolved faster because you contact only one place on your end.

So the answer to your situation is: do the doctors have your correct health coverage information (that you have Medicaid as well as Medicare) and do they accept that payment? If that's the case, then there is an error. Also Medicaid can be slow to pay at times, taking months to pay a bill even when there isn't a billing error.
Helpful Answer (3)
Reply to AliBoBali
Report

I think with Medicaid it also depends on your income. My nephew gets special help because he is very low income. He pays a small amount for prescriptions. Like said, you have to go to a Medicaid doctor. A doctor who doesn't take Medicaid is not suppose to see you. When you signed up for Medicaid you needed to pick a doctor from their list.

Our local Office of the aging handles the Medicaid health insurance. Call them and ask if you can sit with someone who can explain how your medicaid healthcare works. Maybe some adjustment can be made.
Helpful Answer (3)
Reply to JoAnn29
Report

Many doctors and other practitioners are no longer accepting Medicare and Medicaid because the reimbursements to them are so low they cannot make a livable wage. Younger practitioners cannot afford to live and pay off student loans.

My husband and I both are licensed clinical psychologists. I am also a licensed mental health evaluator.  We both are registered Medicaid and Medicare practitioners. We have been able to stay in practice because we have other income sources. We used to receive $67.00 per billable hour reimbursement from Medicare and $59.00 from Medicaid. For a group session it was $13.00. It sounds like a lot of money, but it isn’t. From that amount one must pay for office space, taxes, supplies, continuing education training, utilities, Worker’s Comp, clerical support, computer equipment, billing software to meet reporting/billing requirements for insurance and government and licensing costs. And then the big thing,  liability insurance for our office space -and ourselves. Every year the premium goes up. Congress wants nothing more than to cut back on Medicare and Medicaid. I only practice on a very limited basis. My husband works full time. He only has a limited number of Medicaid patients who are children and accepts no Medicare patients. He probably will stop accepting Medicaid in the fall. Reimbursements to  practitioners at all levels are inadequate.
Helpful Answer (3)
Reply to anonymous439773
Report

My nephew was on full Medicaid and his neurologist didn't take it so he had to switch to Medicaid doctor. When he received Medicare, Medicaid became his secondary. His previous doctor allowed him to come back because as secondary, Medicaid paid quicker. He has a Primary that excepts Medicare but not Medicaid so my nephew pays the difference. On full Medicaid you have to use their doctors as a secondary you can but don't have to. But, u will be responsible for the 20% Medicare doesn't pay.
Helpful Answer (2)
Reply to JoAnn29
Report

See All Answers