Wiki PPO plus Medicaid - copay due?

[jcoil]

I have a patient with a BCBS Medicare replacement plan as her primary insurance, and Medicaid as her secondary. Her BCBS has a $35 copay. Medicaid does not cover this. Does the patient owe this copay (can I bill it?), or do I write it off?

 

[Chelle-Lynn]

When you say that Medicaid does not "cover" the copay....are you receiving a denial? Inclusion? etc.

 

[jcoil]

When you say that Medicaid does not "cover" the copay....are you receiving a denial? Inclusion? etc.

Here's the case: BCBS approved 42.06 and paid 7.06, with $35 copay. Medicaid lists the encounter as "paid", no denial or rejection. on their site, they always list what amount they would approve for the service and what the primary paid. In this case, they list $18.28 as the approved amount, acknowledge that primary paid 7.06, and then they paid zero (again, no errors or denials, it's listed as paid). This tells me that they assume that the patient paid the copay and therefore the practice was paid more than they would have paid anyhow and they owe no more.

Agree?

 

[Chelle-Lynn]

What State are you in?

 

[jcoil]

West Virginia