Wiki Indemnity Plans vs Medicaid

[ericacap11@yahoo.com]

So this patient has Aetna Indemnity... only pays $600 max per surgery. So If I bill that primary... then Medicaid is secondary. What does this mean for us and reimbursement? Will I end up only making $600? Will the patient pay the remaining amount? Medicaid never picks up anything secondary and we lose so much because of that. Do I bill Medicaid? Do I write everything else off? Can I bill the patient? So confusing...

 

[thomas7331]

Medicaid rules vary a bit from state to state, so for a definitive answer, you'll need to reach out to your state's plan for its guidelines. But typically, when Medicaid is the secondary payer, they will pay for services up to their own allowed amount, less any amount paid by the primary insurance payer. So if the Medicaid allowed amount for a given surgery is more than $600, and Aetna has paid $600, then Medicaid would usually pay the difference.

 

[vanessamoldovan]

So this patient has Aetna Indemnity... only pays $600 max per surgery. So If I bill that primary... then Medicaid is secondary. What does this mean for us and reimbursement? Will I end up only making $600? Will the patient pay the remaining amount? Medicaid never picks up anything secondary and we lose so much because of that. Do I bill Medicaid? Do I write everything else off? Can I bill the patient? So confusing...

I agree with the first reponse, but I would also like to add that each state has different rules regarding billing Medicaid patients. Some states say that, regardless if you are PAR or not, if you take the patient's card and "bill" it, then you must follow the Medicaid billing guidelines. Some states only require following the guidelines if the provider is PAR. Most Medicaid websites have a section devoted to policies on billing patients.