Wiki Medicaid as Secondary and copays

[ALozano25]

Is it true that when traditional Medicaid is secondary to any commercial company they do not pick up copays? Just wanting to verify this is true so I am guessing they only pick up deductibles and co ins if primary does not pay more than Medicaid allowable? Please advise.

 

[daedolos]

In California, secondary Medi-Cal will only reimburse the allowable amount designated by Medicare. Also, they will not pay for any DME on our professional claims. I'm sure the policy is different per state.

Peace
@_*

 

[HangarPilot]

The same is true in Florida - they pay the difference between what the commercial insurance paid and Medicaid's allowed amount. For example, suppose the commercial insurance allowed $50 and they apply $20 to a copay and pay $30. All Florida Medicaid cares about is the $30 you got paid. If they normally allow $35.88 you get paid the additional $5.88 and that's it.

 

[ALozano25]

thank you this info is very helpful! yes it seemed like too many to write off if that was the case so I will still bill them!

 

[q1stmdb]

Most states follow this simple formula:

(Medicaid Allowable Amount) Less/Minus (Amount Primary Insurance) = (Medicaid Reimbursement)

In most cases, the primary insurance will pay more than what Medicaid will allow, and therefore the primary copay/coinsurance would have to be written off as an adjustment.