Medicare+Medicaid??

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New agent here. If my client has Medicare and Medicaid and he/she goes to see a specialist who doesn't accept Medicaid (but accepts Medicare), what will happen with remaining 20%? Does he or she get a bill? Or Medicaid gets billed anyway, or something else...?
Thanks for help
 
New agent here. If my client has Medicare and Medicaid and he/she goes to see a specialist who doesn't accept Medicaid (but accepts Medicare), what will happen with remaining 20%? Does he or she get a bill? Or Medicaid gets billed anyway, or something else...?
Thanks for help

They usually won’t accept her unless it's an emergency. She would owe the difference and they know she has no money to pay them.
 
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Interesting... although Medicare is primary payer, they will not accept him/her?


I have had a couple that wanted MA plan, Because there doc did not take Medicaid, They do go and pay the normal copay as a non-medicaid provider

I also have ref source that sometimes needs me to help take someone off an snp to drug plan and OG with Medicaid for better cov with cancer and such, They do from time to time go to a doc that does not except Medicaid and they pay the normal cost share for Medicare
 
Interesting... although Medicare is primary payer, they will not accept him/her?

It’s hard for seniors on Medicare to find a good doctor that is accepting new patients. Even with a supplement. Doctors make much less with Medicare patients than with patents who are not on Medicare.

That is way worse if they are on Medicaid and the office doesn’t accept Medicaid. They are not going to squeeze water out of a rock. The patient has primary insurance that pays 80% but at hugely discounted amounts. Secondary insurance that they do not accept so they will get zero from that. And a patient who is among the poorest of the poor. So they will never pay their bill either.

Does this seem like a customer that you would want to attract if you were a doctor?
 
I understand. However, I didn't know will the dr see you at all, or what are the rules, or who will get billed... I am asking all those questions so I can assist my clients better, educate them and set expectations.
Thank you
 
I understand. However, I didn't know will the dr see you at all, or what are the rules, or who will get billed... I am asking all those questions so I can assist my clients better, educate them and set expectations.
Thank you

This is a good question, but hard to answer. I’ve found that these types of issues are often handled differently and I don’t find that there is an answer that would always address the situation correctly. There should be, but not.

Also, understand that Medicaid is handled differently in each state. It should be fundamentally the same, but certainly not exactly the same in each state.

The way I handle these issues is to tell the client they will have to wait and see. When they get the bills, then we will address it. Of course a strong counseling session up front to keep them in network is helpful. Too bad many times when a patient goes out of network, they have no idea it’s happening.
 
I understand. However, I didn't know will the dr see you at all, or what are the rules, or who will get billed... I am asking all those questions so I can assist my clients better, educate them and set expectations.
Thank you

The fact is most good doctors have enough patients already. They are not “accepting new patients”. Now sometimes with a referal and the right insurance you can get in. Medicaid is NEVER going to get you in unless you are going to a doctor that accepts Medicaid patients.

You can always find an exception here or there. But as a rule you need to assume that dual eligible need to go to doctors who accept Medicaid. Don’t get people’s hopes up unrealistically.
 
The fact is most good doctors have enough patients already. They are not “accepting new patients”. Now sometimes with a referal and the right insurance you can get in. Medicaid is NEVER going to get you in unless you are going to a doctor that accepts Medicaid patients.

You can always find an exception here or there. But as a rule you need to assume that dual eligible need to go to doctors who accept Medicaid. Don’t get people’s hopes up unrealistically.
I guess you could compare a doctor accepting Medicaid to an agent that has a 40% contract. :yes:
 
I guess you could compare a doctor accepting Medicaid to an agent that has a 40% contract. :yes:

Yes. Actually more like you having 120% and people Flooding your appointment setter with call ins and she has you booked up eight weeks out all day every day for as many hours as you want to work and someone else calling in to you and saying Hey I know I’m supposed to go to those other guys but I would like to buck the system and go to you instead and you will only get paid 40% on me. Will you squeeze me in?
 

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