Imagine this scenario…
You have been involved in an automobile accident and were taken by ambulance to your local hospital’s emergency room. During admission, you present your Medicaid information to the hospital. Several weeks alter, you are surprised when you start receiving billing statements from the hospital. When you call to inquire as to why this treatment was not filed on your Medicaid, you are informed that the hospital has the right to refuse to file Medicaid, so you will have to pay the full balance.
Being involved in an automobile accident can be life changing. In many instances, an innocent person may be left injured and out of work for a prolonged period of time. Even though there is reduced income stream, life does not slow down and bills continue coming. The injured party not only has to deal with his or her injuries but also has to figure out how to pay the bills. This problem is compounded when that person starts receiving bills for treatment that could have otherwise been paid for by Medicaid.
Does a medical provider have the right to refuse to file Medicaid?
Unfortunately, there is no broad-based answer to this question. Unlike Medicare, which is federally controlled and is uniform across all states, Medicaid is governed differently from state to state. To answer this question you will need to turn to the Medicaid Administrative Code for your state. This article focuses on Alabama code.
The Alabama Medicaid Agency Administrative Code states that any medical provider has the absolute right to choose to accept or deny Medicaid payment on a patient (Section 560-X-1-.07(3)). This is true for any medical treatment and is not limited to accident related injuries. However, if the provider elects not to file Medicaid, there are several steps that must be taken.
The medical provider must decide whether Medicaid will be accepted prior to providing treatment…
The provider must make this determination before providing treatment to the patient. In order to refuse to accept Medicaid, “The provider (or their staff) must advise each patient prior to services being rendered when Medicaid payment will not be accepted, and the patient will be responsible for the bill. The fact that Medicaid payment will not be accepted must be recorded in the patient’s medical record,” (Section 560-X-1-.07(3)). This is a procedural requirement that must be met in order to deny to accept a patient’s Medicaid. If the medical provider does not inform the patient that Medicaid will be refused prior to providing treatment, the provider has not met the procedural requirements, and has accepted that patients as a Medicaid recipient and is obligated to file the related treatment with Medicaid.
If the medical provider does not properly deny Medicaid, any associated bills should be addressed with Medicaid…
Once a patient is provided treatment as a Medicaid patient, the medical provider should present any related medical bill to Medicaid. “The medical provider should not send the patient billing statements other than for any allowable copayment amount,” (Section 560-7-.24(3)). The medical provider should turn to Medicaid for any unpaid bills, other an copayments, and is obligated to accept the amount paid by Medicaid as payment in full on the bill.
How can you contest a bill that should be filed on Medicaid?
I would like to say that medical providers always follow these guidelines. However, in my daily dealing, I have often found that to no be the case, especially in the instance of a visit to the emergency room. I am not implying that hospitals are trying to cheat patients; rather, it is my contention that in most instances there is either poor education or poor communication on the part of the hospital and their billing offices.
In many circumstances, even when billing error is pointed out, there is still reluctance on the part of the medical provider to file the given treatment with Medicaid. In such a situation, the patient should not just assume that they are responsible for the entire medical bill. Instead, they should contact an attorney who may be able to assist them in reaching a resolution with the medical provider on the bill.