Medicare Advantage and Medicaid

[juliagreen1968@gmail.com]

We had a patient come in with a medicare advantage plan. When we billed them for the co-pay, they then came back with their Medicaid information. This was not presented at the time of service. We are not Medicaid providers. Can we bill the patient for the co-pay?

 

[taysin93]

Yes, you can bill for the copayment. even though provider accept Medicaid, you still have to collect copayment from the primary insurance.

 

[carrab]

No. There is a federal rule that prohibits balance billing of dual eligible patients.
Page 6-https://www.cms.gov/files/document/dualeligiblesproviderenrollmenttplfaqs.pdf#:~:text=Q7%3A%20Can%20a%20Medicare%2Denrolled%20or,is%20not%20also%20enrolled%20in

 

[whughes9805]

Most likely the primary insurance medicare advantage is a dual plan. The dual means medicare and medicaid combined. Therefore you cannot bill the patient for it