Ophthalmology and Optometry Coding Alert

Question: We recently saw a Medicaid patient, but at the time of service he did not provide insurance information. He received statements as self-pay and finally contacted our office to tell us he may have had Medicaid but was going to contact them to verify eligibility. We never heard from him again. Are we within our rights to submit him for collections?

California subscriber

Answer: Yes, if you confirm that the patient is not on Medicaid, you can ask the patient for payment.

If the patient has received a notice of action stating that he no longer qualifies for Medi-Cal due to changes in income or household, he should be able to enroll in a health plan through Covered California, but he must act fast. Medi-Cal allows only 60 days from the date listed in the notice of action to enroll in Covered California under special enrollment. If the patient does not enroll within this period, then it is the patient’s responsibility to pay for the services.