A Medicaid Patient Had a Heart Attack While Traveling. He Owed Almost $78,000.

[Duaine]

The Final Bill

$95,523.73, including $32,998.90 for medical supplies, mostly related to the stents, and $28,879 for treatment in a cardiac catheterization lab. After unspecified hospital adjustments to the bill, Wirt owed $77,574.44.
[EXTERNAL LINK] - A Medicaid Patient Had a Heart Attack While Traveling. He Owed Almost $78,000. - KFF Health News

 

[somarco]

Wirt is covered by Florida's Medicaid program through Sunshine Health, a managed-care plan. But the South Dakota hospital refused to submit the bill to his out-of-state Medicaid plan, instead sending it to Wirt and eventually threatening to send the debt to a collection agency.



Bummer!

Medicaid, LIS, dual, etc is not my market but I had no idea it works, or doesn't work, like this.


Federal law says state Medicaid programs must reimburse out-of-state hospitals for beneficiaries' care in an emergency.

Many hospitals bill out-of-state Medicaid plans in such situations. If they don't, they risk not being reimbursed at all, since Medicaid recipients probably won't be able to afford large bills, said Katy DeBriere, who was legal director for the Florida Health Justice Project when she spoke with KFF Health News in April.

But there's no federal law that requires them to do so, she said.

Catch-22 . . .

 

[Limozine]

So the hospital would rather pay for collection services, attorneys fees, etc. (and still never get paid by the patient) rather than just...bill Florida Medicaid? Sounds about right. My experience has been that the providers/hospital systems are a bigger problem than the insurance carriers due to their pathological refusal to work with the system.