My doctors are not par with Medicaid. So when a patient comes in to the office with Medicaid as their sencondary insurance we are having them sign a Medicaid Waiver which states that we are not par and they are responsible for the balance. Is this legal! and what if Medicare is the primary insurance, does that make a diffrence?
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Wiki Medicaid Waiver
- Thread starter Pat Liebl
- Start date
mitchellde
True Blue
If the patient has Medicaid then it means they are financially indigent with no means to pay for health care. If your patient had Medicaid either primary or secondary then they must be sent to a provider that does accept Medicaid. Part of the disadvantage if you will of being on Medicaid is that the State can restrict your access to providers, as a recipient you accept that. So no you cannot have the patient pay out of pocket when they have declared to the State that they have no means
andersont
Guru
We are a Medicaid provider and if a medicaid patient is seen for something that is not or may not be covered, we have them sign a waiver saying they are responsible.
mitchellde
True Blue
you should really check with your Medicaid laws, different states are different and there are different forms of Medicaid, spend down, straight, HMO, just to name a few, it really depends on the state and type of Medicaid as to whether this is allowed. Medicaid will cover the basic medically necessary services, if the patient's medical condition requires services that are deemed not covered and the provider feels the patient truely needs the service for quality of life then you should request a waiver of medical necessity from Medicaid. Remember the patient is eligible for Medicaid because they have convinced the State that they are unable to afford medical services. If this is the case how can you have the patient elect to pay out of pocket for services deemed not medically necessary?