Wiki Medi-Cal confusion

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adwilmar

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hello, looking for an answer to:

If a patient has Medicare and Medi-Cal as the secondary and she sees a provider that is a Medicare participant but NOT a Medi-Cal participant, can the provider bill the patient for the remaining 20% that Medi-Cal would pay if the provider was a participant? or is that against the law in California?

Thank you in advance.
 
Although the provider is not enrolled in Medi-Cal, the patient cannot be billed. Medi-Cal beneficiaries can never be billed except in the case that the patient has a Share of Cost and even then, they can be billed only by a Medi-Cal provider.
 
If you knew the patient had medi-cal, you are suppose to have the patient see a medi-cal provider. These patients have accepted this state assistance and are then required to use only the state contracted providers, they are not allowed the option of choosing any provider they want. The problem is by choosing to see the patient anyway and then either trying to bill the patient or not, can have the effect of the patient listing the medi-cal coverage in the future.
 
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I'm so glad I came across this!!! I have a provider that is not participating with Medi-cal but is requesting that we bill the patients for the services. I advised her that we cannot bill the patients. I am trying to locate some sort of documentation that supports this but cannot find anything. Does anyone have something they can share or direct me where to go?? I have already looked on Medi-cal's website but I can't find anything....

Thanks for your help!!!
 
SCCL5558 said:
I'm so glad I came across this!!! I have a provider that is not participating with Medi-cal but is requesting that we bill the patients for the services. I advised her that we cannot bill the patients. I am trying to locate some sort of documentation that supports this but cannot find anything. Does anyone have something they can share or direct me where to go?? I have already looked on Medi-cal's website but I can't find anything....

Thanks for your help!!!
Click to expand...

I'm on the same boat, looking for documentation that a non-Medi-Cal provider cannot balance bill a California Medi-Cal patient. If anyone knows of any references I can comb through, please let reply. That will be greatly appreciated!
 
I'll look over this as well. Thanks!

Just a heads up, for those providers that are not contracted with Medi-cal and do not want to contract with them, you can send in an application for just crossover patients. This would only be for Medicare and Medi-cal patients. That way your provider isn't losing out on the 20% or if Medicare applies any of it to the deductible. Medi-cal has the application listed as a "CROSSOVER APPLICATION".

Hopefully that all makes sense. I working on 3 hours of sleep:(
 
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