Dual Eligible Question

[Josh]

In reference to what you say about Medicaid virtually paying 100% of the time....
I'm still not sure I understand the whole out of network thing. I was told that the client might have extra out of pocket if they are out of network with MA even when they go with a medicaid provider. Is this wrong? or is it if they go to a non-medicaid provider that there may be a balance owed to doctor?

Virtually 100% of the time, yes. If a doctor participates with Medicaid, they can't bill Medicaid and take one cent from the client (almost 100% of the time). To put it another way, they can't balance bill a Medicaid patient, regardless of what the Medicare status is.

If they go to a non-medicaid provider, the doctor can balance bill anything they darn well please subject to the agreements they have with other providers.

 

[arnguy]

I think jmarkk1 is in North Carolina according to his state flag, so how did Texas get into this conversation MPS?

 

[Josh]

I think jmarkk1 is in North Carolina according to his state flag, so how did Texas get into this conversation MPS?

Good call.

Just replace "Texas" with "North Carolina".

 

[arnguy]

Uderstandable error, MPS< the flags look similar except for the white star in the Texas flag. Texas must have ripped off the North Carolina flag!

 

[jmarkk1]

Uderstandable error, MPS< the flags look similar except for the white star in the Texas flag. Texas must have ripped off the North Carolina flag!

Actually, I'm in Ohio....sorry I haven't changed my state flag since being in NC.

 

[Josh]

Actually, I'm in Ohio....sorry I haven't changed my state flag since being in NC.

Even better! Replace "Texas" with any state you're in Except there are a few that are goofy about things.

 

[taterpeeler]

I think jmarkk1 is in North Carolina according to his state flag, so how did Texas get into this conversation MPS?

Simple..Texas is the great state...those that don't like it are just ignorant

 

[GreenSky]

Simple..Texas is the great state...those that don't like it are just ignorant

Those of us in the other 57 states think of TX simply as OK South.

Rick

 

[arnguy]

oops, I thought we considered Texas as Mexico North!

 

[GreenSky]

oops, I thought we considered Texas as Mexico North!

That's California.

Rick