The key is, Medi-Cal has to agree that the services were medically necessary and that they met the criteria needed to be considered "Emergency" care. Most payers base that criteria on the place of service code, provider type, and of course, the nature of the presenting problem. You need to have made an honest effort to verify coverage for the procedure (to the extent possible, given the circumstances), and have a record of why you were unsuccessful - whether it was due to the patient's condition, misinformation from the insurer, or because you were unable to verify coverage due to the insurer being closed. If you did everything in your power to take care of your end, and your appeal denies anyways, then you should be able to bill the patient for the services. (Hint: The EOB should indicate an amount applied to patient responsibility - if you're not sure, ask Medi-Cal)
But...if you had ample time to verify coverage (as in, a day or more), but no one took care of doing it (i.e., you just saw Medi-Cal and assumed that they had regular Medicaid, and not pregnancy-only care), then I probably wouldn't bill the patient - I'm not saying that you can't, necessarily, but I personally wouldn't consider that a good business practice, on principle. Providers usually have a contractual responsibility to verify coverage prior to rendering services, and if that didn't happen because somebody dropped the ball, then it's not entirely the patient's fault that they got non-covered treatment. As long as there's nothing in your contract (or provider manuals) prohibiting it, you can bill patients for medically necessary non-covered services; the catch here, is that the patient should have been advised of the possibility of being made responsible for payment, so they could have made an informed decision as to whether or not they still wanted to go through with it. If your office never checked to see if such a possibility existed, then you certainly couldn't have communicated it to the patient; and I'm doubtful that they'll be singing your doctor's praises if they get the impression that they were tricked into getting stuck with a bill they weren't expecting to have to pay. That's just my 2 cents, though - you should absolutely call Medi-Cal and get the answer to this straight from the horse's mouth.
Your agreement to accept Medi-Cal's payment in full for services rendered only applies to covered services - it's to keep you from balance billing them for your contractual write-off amounts and for services that denied as being inappropriately billed (coded), not to keep you from getting paid for providing care that doesn't fall under their regular benefits.
Hope that helps!
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