Pkirsch1
Networker
Can a patient opt out of insurance when they have Medicaid? Is there a form to fill out?
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Wiki OPT OUT OF INSURANCE
- Thread starter Pkirsch1
- Start date
By opt out of insurance, do you mean opt out of having another type of insurance (such as through an employer)? Or opt out of their primary insurance being billed?
If you mean the second scenario, Medicaid will require the primary to be billed for COB purposes. Medicaid is always the tertiary payer - they will not pay without a primary EOB.
(If for some reason Medicaid isn't currently aware that the primary policy exists, they may pay your claim now. However, once Medicaid finds out about the primary they will come back and recoup your payment. Even if it's years later. Then it's just a messy process for you to try to bill the primary after the recoupment. Sometimes that happens because the provider simply had no idea the patient had other insurance on the DOS. If you know the other insurance exists, you should bill it as primary before Medicaid.)
Most likely the patient knew that they are out of visits for the year with Medicaid. They get 12 visits /FY . A do not file on the claim is what we do, and they pay for the visit. Children are a different case thou, you can get an extension.
Pkirsch1
Networker
If the provider is not credentialed with DSS, can the patient agree to self pay?
thomas7331
Guest
If the patient, by their own choice, is requesting that you not submit claims to their insurance and asking to self-pay for the visit instead, they are within their rights to do that and you can collect payment from them.
If however, they are presenting as a Medicaid patient but your practice is telling them that they must pay for the visit because your provider is not participating with Medicaid, my guess is that you can probably do this if you've given the patient advance notification before receiving services, but I would recommend you review your state's guidelines to ensure that you are in compliance with your state laws in how you go about it. Your state's Medicaid provider manual likely has a section spelling out the circumstances under which you may collect payment from an enrolled patient.
SharonCollachi
Guest
Is this the real question? Or is there more? The first question felt like there wasn't enough information.
Unless your state law prohibits it otherwise (and I'm not aware of any who do), any person who has only Medicaid for their health care needs is free to seek care from anyone they choose. If they choose to see a provider who is not enrolled with Medicaid, you would be smart to have them sign a financial responsibility form (just make one up if your local Medicaid doesn't have one on their website - some do) that is similar to the ABN that Medicare uses. It would say something like: "I understand that Dr. XXXXXX is not enrolled with Medicaid and therefore is not able to bill Medicaid for services provided to me. I understand that I am solely financially responsible for those services."
By the way, if the patient has a share of cost, they can submit receipts to their Medicaid worker and have that count for meeting their share of cost, even if you don't bill Medicaid yourself.
Now if the patient has any other insurance, including Medicare, that is an entirely different scenario with different answers.