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 there has been a change in her copay status, as Medicaid regulations typically require providers to bill Medicaid first before charging the patient a copay.

Step-by-step explanation:

When faced with a situation where a medical provider requires a copay that is not listed on a Medicaid insurance card, it is advisable for the beneficiary to verify the accuracy of the billing practices with their Medicaid plan. Medicaid regulations typically stipulate that providers bill Medicaid before billing the patient for a copay, especially when the patient's insurance card shows no copay. Thus, from the options provided, Marge should consider option number 2, as it is generally illegal to bill Medicaid patients before billing Medicaid first. Additionally, Marge may also want to undertake option number 3 to ensure she has the most current information regarding her copay status with Medicaid. It would be best for her to contact Medicaid directly to clarify her plan's benefits and any copay requirements.