Wiki Medicare Part C as primary/Medicaid Secondary

[lisasulsar@gmail.com]

Needing some help -
We are seeing a patient with a UHC medicare advantage part C plan as their primary insurance, with Medicaid QMB as secondary. We participate with the patient's primary, but are OON with all medicaid. I was under the impression with Medicaid QMB we cannot bill the patient for their copay, but now he has an upcoming surgery I am concerned will not be paid.
As far as billing, what is the best way to approach this? Can we bill the patient their copay if we let them know in advance?

Thanks in advance!

 

[Pam Warren]

Whether or not you're OON with the 'caid, the bill is the patient's responsiblity, and yes, you can bill them. When signing informed consent, your form should have a disclaimer on there about their need to be responsible for the bill, regardless of the insurance situation. That having been said, the fact that they're on Medicaid means that they probably don't have a lot of loose change. Decide how much Medicare is going to pay, how much they will owe, and you can have the discussion with them, and should attempt to collect. Whether they pay you or not is anyone's guess.

 

[CatchTheWind]

If a patient is a QMB and has Medicare primary, it is illegal to collect the out-of-pocket portion from the patient. You are required to write it off (or get it from Medicaid if you participate and if they will pay anything).

Is this different when the patient has a Medicare Advantage plan instead of traditional Medicare?