|
Linda
Brandwin, R.N.
|
 |
Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
|
Non-participating
specialists can join Medicaid for one-time service
April 16, 2004
Q: My cousin
has Medicaid insurance due to being unable to work.
She was admitted to the hospital through the emergency
room. Her physician requested a consultation from a
specialist to aid in her treatment. It turns out this
specialist does not participate with Medicaid. My cousin
is now getting letters from the physician's office threatening
to send her to collections.
She
was sick and flat on her back in a hospital bed. How
was she to know this specialist did not participate
with her insurance? She was in a participating hospital
and her physician was participating, so she never once
thought about the specialist not being a part of Medicaid.
It was on her physician's recommendation that the specialist
was called in, not hers. Is she liable for this bill?
A:
Every
state has its own laws regarding Medicaid. However,
usually if a physician does not participate with Medicaid,
he can bill the patient his full fee. The patient is
liable for this bill. Your cousin should call her local
Medicaid office and verify this.
Also,
many states allow the non-participating physician to
temporarily join Medicaid just to collect fees for this
one time service for a particular patient. The physician's
office would need to call Medicaid for this information
and the enrollment forms.
Many
physicians, when called in for a consult, check the
patient's insurance information before the exam. This
eliminates many insurance coverage problems. At this
point the physician could recommend a participating
Medicaid provider for the consult or work out a payment
plan with the patient or her family. There would be
no surprises. Unfortunately, this physician did not
do this.
Your cousin should call the specialist's office. She
should try to speak to the doctor, but if she can't,
she should talk to the office manager. She needs to
explain that this bill is a hardship, she is not employed,
and she is a Medicaid recipient. She should also explain
she was not in a position to be aware that a non-participating
doctor was seeing her while she was hospitalized. She
can suggest that the doctor call the Medicaid office
to sign up on a temporary basis so he can be reimbursed
for his service to her. She can also ask for a hardship
discount and try to work out a payment plan with the
doctor that would fit her budget. Hopefully, the specialist's
office will accommodate your cousin. Unfortunately,
if they are not willing to work with her, she will be
liable for the entire bill. Again, your cousin needs
to confirm her liability in this situation with her
local Medicaid office.
|
