Wiki Provider non par medicaid, but medicaid secondary payer

[ali2gark]

Hi, a patient has private insurance primary which covers this providers' services however the patient has Medicaid as the secondary payer. This provider doesn't participate with Medicaid. Is the patient able to be billed for the deductible and co-insurance amount as the provider can't bill Medicaid? Or is there a legal/ethical issue? Does Medicaid ever pay a non-par provider in situations like this? Thoughts would be welcome.

 

[thomas7331]

I think it would really depend on the regulations for that particular state's Medicaid plan. But typically providers cannot bill Medicaid patients for anything other than what is designated as patient share on the EOB unless the provider either notified the patient in advance that the service would not be covered, or if the provider can prove that the patient did not tell them that they were enrolled in Medicaid at the time of service.