Wiki Cash Pay vs Medicaid Plan

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domaha28

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Patient picked a medicaid product insurance plan that present PCP does not participate in. Can the patient pay cash for office visits even though she has a medicaid product? We would not sent to insurance, just accept the cash from patient. Thanks! :confused:
 
Cash VS Medicaid Payment

If a patient selected a Medicaid HMO and your doctor is not in network with that you can accept cash or bill Medicaid directly, bypassing HMO ( if its MMC) in NY. You will need to bill HMO for denial and then submit claim to to Medicaid as secondary with 0-fill for a primary ins.
But its always better to inform patients that they need to go to in-network provider.
 
Thank you! I was always with the understanding that if they had Medicaid or a managed care medicaid product, we could not bill the patient for anything including no show's. Also was told we could not bill Medicaid if they had Managed Care Medicaid Plan. Interesting....
 
domaha28 said:
Thank you! I was always with the understanding that if they had Medicaid or a managed care medicaid product, we could not bill the patient for anything including no show's. Also was told we could not bill Medicaid if they had Managed Care Medicaid Plan. Interesting....
Click to expand...

I am in the same frame of mind as you. I worked for Medicaid for several years although not in NY and we were emphatic about patients that were covered by Medicaid, if they wanted to pay out of pocket for things (like cosmetic procedures) then pehaps they did not really qualify for Medicaid. If the patient has signed up for been assigned to a Medicaid HMO then it is for specific reasons due to their circumstances as they communicated to the state, I do not believe they can chose a provider outside that plan, But perhaps NY is different.
 
https://www.emedny.org/ProviderManu...n_for_All_Providers-General_Policy_2011-1.pdf

The above is the site where the Provider General Guidelines for NY Medicaid program can be found. On page 11 of the manual it states the following:

"When Medicaid Enrollees Cannot be Billed
This is the policy of the Medicaid Program concerning the enrollee, including those Medicaid enrollees who are enrolled in a Managed Care Plan and in Family Health Plus.

Acceptance and Agreement
When a provider accepts a Medicaid enrollee as a patient, the provider agrees to bill Medicaid for services provided or, in the case of a Medicaid Managed Care enrollee, agrees to bill the enrollee’s Managed Care Plan for services covered by the contract. The provider is prohibited from requesting any monetary compensation from the enrollee, or his/her responsible relative, except for any applicable Medicaid co-payments.

A provider who participates in Medicaid fee-for-service but does not participate in the enrollee’s Medicaid Managed Care Plan may not bill Medicaid fee-for-service for any services that are included in the Managed Care Plan, with the exception of family planning services. Neither may such a provider bill the enrollee for services that are covered by the enrollee’s Medicaid Managed Care contract unless there is a prior agreement with the enrollee that he/she is being seen as a private patient as described above.The provider must inform the enrollee that the services may be obtained at no cost to the enrollee from a provider that participates in the enrollee’s Managed Care Plan.

Private Pay Agreement
A provider may charge a Medicaid enrollee, including a Medicaid enrollee enrolled in a Managed Care Plan, ONLY when both parties have agreed PRIOR to the rendering of the service that the enrollee is being seen as a private-pay patient. This must be a mutual and voluntary agreement. It is suggested that the provider maintain the patient’s signed consent to be treated as private pay in the patient record.

Information for All Providers
–
General Policy Version 2011-1 June 1, 2011 Page 11of 64"

Hope this helps. I don't work with NY Medicaid and only googled cause I was curious.
 
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There are a few states that will allow providers to enter into private pay agreements. The best source of information is your state's medicaid website. The provider manuals and requirements are all there. My advise to anyone with these questions is the check the website first, since each state has its own rules for medicaid you will most likely find your answers quicker that posting on these forums.
 
I used to do a lot of Texas Medicaid for a pediatric practice. We were a contracted Medicaid provider but anything outside of Medicaid coverage, we always had a very clear and easy to read document signed by the Medicaid client/guardian that ear piercing or whatever was NOT a benefit of Medicaid and the client was paying privately for said services.
 
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