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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.
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.
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.
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.
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.
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.
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