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Thread Topic: PATIENTS WITH PRIVATE INSURANCE AS PRIMARY AS WELL AS MEDICAID
Topic Originator: ANDREA
Post Date April 17, 2016 @ 10:05 PM
PATIENTS WITH PRIVATE INSURANCE AS PRIMARY AS WELL AS MEDICAID


ANDREA
April 17, 2016 @ 10:05 PM Reply  |  Email Friend   |  |Print  |  Top

We see several patients with private/commercial plans. These patients also have Medicaid, for example, Blue Care, United Healthcare Community Plan, and Amerigroup. When we verify patients' insurances their insurance eligibility profile only shows the one or the other separately. Both are not listed as coordination of benefits. We are participating with both plans and billers have been advised that Medicaid is the payer of last resort. Once we bill private/commercial we have been billing the deductible portion to Medicaid and have not been getting any payments. I understand this is likely due to the low fee schedule for Medicaid. I have now advised the billers to not bill the Medicaid so that we can bill the patients directly for their deductibles and coinsurances. Please let me know how you are dealing with these issues in your practice. Thank you.

ivy
June 25, 2016 @ 9:21 PM Reply  |  Email Friend   |  |Print  |  Top

I think every state Medicaid have their policy. In NH Medicaid they don't pay copay, and if commercial insurance paid more than Medicaid allow. Medicaid did not pay.

Michelle
July 14, 2016 @ 9:01 AM Reply  |  Email Friend   |  |Print  |  Top

If you agree to take medicaid you can not bill the patient. you will have to write the balance off. If primary insurance pays more than medicaid rate, medicaid will not pay any additional payment.

ANDREA FULLER
July 25, 2016 @ 12:02 PM Reply  |  Email Friend   |  |Print  |  Top

Thank you. I appreciate your feedback.

ANDREA FULLER
July 25, 2016 @ 12:05 PM Reply  |  Email Friend   |  |Print  |  Top

Thank you.

Emmy
August 10, 2016 @ 9:44 AM Reply  |  Email Friend   |  |Print  |  Top

You are correct, Medicaid is the payor of last resort. You are required to bill the Medicaid and cannot bill the patient for the coinsurance (copays and deductibles) after the primary insurer has paid if the patient also has Medicaid and your provider is participating.

emmy
August 10, 2016 @ 9:48 AM Reply  |  Email Friend   |  |Print  |  Top

In the majority of cases the coinsurance will end up being written off as a Medicaid contractual, because the Medicaid fee schedule is typically lower than the primary insurance fee schedule so the primary payment has typically already exceeded the allowed medicaid.

emmy
August 10, 2016 @ 9:48 AM Reply  |  Email Friend   |  |Print  |  Top

After billing medicaid you may find that the patient still owes for their Medicaid copay, so make sure to review your Explanations of benefit.

Kim Palmore
July 25, 2016 @ 11:48 AM Reply  |  Email Friend   |  |Print  |  Top

In Texas you can not bill the patient if you have agreed to take Medicaid. The only time we can bill a patient that has Medicaid is if Medicaid say its patient responsibility.



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