Medicaid and Part B Deductible

[yabadabadoo1026]

I just ran into this with a UHC customer. The computer in the front end of UHC (from what I am told) shows the customer as having full medicaid. The claims department computer is not showing her as having Medicaid at all therefore she is being charged the $147.
We haven't figured out how to solve this issue yet.

Penny, my client has CIP. Keep us posted on yours. I told this woman to dig thru her pile and find the EoB s and see if anywhere it show her owing 147---I tell these folks to be guided by the EOB and not bills from the doctor. Sometimes these doctors send the patient at bill before they been paid by Medicaid and I'd suspect often paid twice. I know a complicated call can be made but got to train these folks to keep EoBs for a while at least so going to let her go thru some trouble digging

 

[MedicareAgent]

We have her eob and it says she has to meet her $147. deductible. I'll let you know the outcome.
I was told by two people at UHC that it was a computer communication error and it would be escalated and yet 4 months later we still wait.

 

[Josh]

put a client on a dual advantage plan and she is claiming the doctor is wanting her to pay the 147 saying Medicaid doesn't pay that. Certainly I don't think on an advantage plan--dual or otherwise--there is that deductible BUT if on traditional Medicare with full Medicaid does Medicaid pay that 147. I was thinking Yes but the more I think about it I can see that perhaps it could be Ni--------haven't been able to find anything on the net on it yet

If the doc is par with Medicaid then usually that contract means they aren't allowed to bill anything outside of what Medicaid allows, which is usually some flavor of nothing. On the other hand, if the doc is par with the MA plan but non-par with Medicaid, they can charge for anything allowable by the MA plan which could include deductibles.

Does that help?

 

[yabadabadoo1026]

We have her eob and it says she has to meet her $147. deductible. I'll let you know the outcome.
I was told by two people at UHC that it was a computer communication error and it would be escalated and yet 4 months later we still wait.

That is BS and a UHC blowoff you shouldn't accept---------if I were you I would help her file a grievance or appeal and that should get a speedy response. My gal was advised of this 147 due when she went to the doctor in December , the first month had her on CIP. I'm contending to it her its likely a deductible from earlier in year when she was on traditional Medicare that they didn't make her aware of it being unpaid till December. So shes blaming it on CIP and perhaps unfairly---till I heard your story so maybe it is a CIP issue-- and wants to disenroll. I probably will gladly let her, shes bi-polar and hard to deal with , told me her doctor of many years told her not to come back again when she pitched a fit, lol. So my question reverts back to trad Medicare if Medicaid pays that 147 which I thought it did but perhaps not?

 

[MedicareAgent]

Medicaid DOES pay the $147. I have never run in to this problem before so I am following the directions I am given and the chain of command to sort this out, I will not allow it to just sit, we are pursuing it.

 

[yabadabadoo1026]

Medicaid DOES pay the $147. I have never run in to this problem before so I am following the directions I am given and the chain of command to sort this out, I will not allow it to just sit, we are pursuing it.

if its been 4 months with no answer then it is just sitting ie ignoring you till you go away

 

[MedicareAgent]

Not at all, that is the escalation team that is sitting, not us, we are doing other things to resolve this matter.

 

[yabadabadoo1026]

If the doc is par with Medicaid then usually that contract means they aren't allowed to bill anything outside of what Medicaid allows, which is usually some flavor of nothing. On the other hand, if the doc is par with the MA plan but non-par with Medicaid, they can charge for anything allowable by the MA plan which could include deductibles.

Does that help?

Thanks for contributing to the discussion---I'm not familiar with any MAPD plan that has a Part B deductible contained.

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Not at all, that is the escalation team that is sitting, not us, we are doing other things to resolve this matter.

lol, now that is some kind of 4 month escalation-----I cant imagine what you could do outside of UHC that would make it go away other than the doctor just saying screw it and it going away

 

[Josh]

Thanks for contributing to the discussion---I'm not familiar with any MAPD plan that has a Part B deductible contained.

I totally missed that. I know there used to be some plans that would intentionally mirror the Original Medicare benefits for duals, but that's more regional. Obviously you know the service area so even if a plan in NY had those, it wouldn't matter because you'd be limited to the ones in that area (unless they moved around).

Whatever the case is, if a provider is contracted with Medicaid, that agreement includes a limitation on what they can bill the client. Each state can set it's own rules, but if there was a deductible from anything (Medicare, car insurance, workers comp, etc, literally anything), but the doc was par with Medicaid, the buck stops with Medicaid. If their Medicaid agreement says they can charge a $1 copay, that's it, not a penny more. If you call the local Medicaid office (which is usually a giant PITA), they can usually answer that right off the top of their head.

 

[yogooglethis]

put a client on a dual advantage plan and she is claiming the doctor is wanting her to pay the 147 saying Medicaid doesn't pay that. Certainly I don't think on an advantage plan--dual or otherwise--there is that deductible BUT if on traditional Medicare with full Medicaid does Medicaid pay that 147. I was thinking Yes but the more I think about it I can see that perhaps it could be Ni--------haven't been able to find anything on the net on it yet

Unless you enrolled her 1/1/15 or before you need to clarify if this isn't from when she was on original medicare and hadn't met 2015 part B deductible and also make sure the provider is billing to correct payer.

In Florida a provider who renders services to a full dual eligible are not allowed to balance bill the patient whether or not the provider accepts medicaid.Happens all the time but they are breaking a rule as a medicare provider when they do.