Question

Marge has Medicaid and goes to see the chiropractor once a week. The chiropractor takes Medicaid but informs Marge that she has a 25 copay for each visit. Marge's insurance card lists no copay. When questioned, the billing office tells Marge that her insurance only reimburses 17 per chiropractic visit and it would cost them more to bill her insurance than it would just to have her pay–and it's only 25. According to Medicaid regulations, what should Marge do?

1) It is illegal to bill Medicaid patients without signed consent.
2) It is illegal to bill Medicaid patients before billing Medicaid first.
3) Marge should call Medicaid to see if her copay has changed.
4) Marge should ask to pay 17 per visit.

Answer 1

Marge should verify with Medicaid whether she has a copay and if so, how much, as it is illegal for providers who accept Medicaid to charge patients before billing Medicaid and without signed consent. She should also confirm whether the provider's request for a $25 copay aligns with her Medicaid plan details.

Step-by-step explanation:

Medicaid and Chiropractic Visits Copay Issue

Marge is facing a situation where her chiropractor, who accepts Medicaid, is requesting a $25 copay for each visit despite her insurance card listing no copay.

According to Medicaid regulations, it is important for Marge to understand her rights and the provider's obligations. Providers who accept Medicaid are typically required to bill Medicaid before charging the patient. Furthermore, charging a copay without the patient's consent may not align with Medicaid's rules.

The following steps should be considered by Marge:

1. It is illegal to bill Medicaid patients without signed consent, making it important for Marge to verify her consent for charges.
2. It is illegal to bill Medicaid patients before billing Medicaid first, implying that the chiropractor should bill Medicaid prior to requesting a copay from Marge.
3. Marge should call Medicaid to find out if her copay has changed. This will also confirm whether the information provided by the chiropractor is consistent with her plan details.
4. Asking to pay $17 per visit is not a valid option unless it aligns with an updated policy in her Medicaid plan, which needs to be confirmed.

It is crucial for Marge to validate these details with Medicaid directly to ensure that she is not being inappropriately charged and that the provider is following Medicaid's billing requirements accurately.