Question:
Dr.'s that charge outside of insurance?

I was just approved thru Medicaid, but my surgeon is charging anywhere from $1000-$1500 before he will schedule surgery. Is this Legal? I don't have the money but should I try and grt it or look for another surgeon?    — missperry (posted on September 12, 2001)

September 12, 2001
I would consider looking at other surgeons. Believe it or not, this is not uncommon. Many MO people go to surgeons--believing they accept medicaid. In actuality, the surgeon or hospital charges you for the cost over and above what medicaid pays for. I'd suggest looking for people in your area that have had the surgery with your insurance and see if they ran into this problem. There are actually doctors out there that realize if you have Medicaid, you usually do not have a few thousand dollars just laying around the house. Good Luck~
   — [Anonymous]

September 12, 2001
Many physicians do not participate as a Medicaid or Medicare provider. This is also common with Blue Cross and some other private insurances. When a physician participates in the insurance companies plan they agree to accept their reimbursement as payment in full. If they do not participate they are allowed to bill patients for the difference in thier fee and the insurance payment. For example: Say a physician usually charges $6,000 to do a WLS procedure but Mcaid or Care only agress to pay $2000, it he surgeon participates in the plan that is all he can charge the patient. It would be illegal for him to charge more for the procedure. However, if he does not participate in the plan he can charge what he wants in order to make up some of the difference. I have been told that some of the doctors charge for support group follow up as a way of offsetting these losses. This will vary from dr to dr so check around. This will also vary with insurance plans and in some states Mcaid plans vary. Some people have spend downs and some insurances require a co pay. make sure you know what your coverage is and then talk with the Dr billing person to see what options you may have in meeting your financial obligation. One of the surgeons where I live has worked with a local bank to help patients get low interest loans to pay for the cost of their surgery. If you are on Mcaid I know your financial resources are limited and it may be more difficult for you. Just don't give up there are plenty of people on this site who have struggled to get ins reimbusement or other financial resources . I would also ask your dr's office exactly what those additional charges are for. good luck!
   — [Anonymous]

September 13, 2001
If this doctor agrees to accept you as a Medicaid client, then it is illegal and absolutely forbidden for him to ask you for even one penny. Medicaid is probably the best insurance out there as there are no deductibles, copayments and no legal hassels and intimidation from bill collectors. I would call the state insurance commissioner and check this guy out. Well, ask the doctor first, (you did before you even went there, didn't you) if he accepts Medicaid. Chances are that the first question the office asked you when you called to set up the initial appointment was, "What type of insurance do you have?" because if they don't accept your company, whether private or governmental, they let you know it immediately, won't even schedule the appointment. So what did they say to you? Then go from there and if he does accept Medicaid, then you must file a legal complaint with the proper authorities. If he doesn't accept Medicaid, then find someone else who does and move on. (And find out what to do about the charges for the other office visit)
   — Fran B.

September 19, 2001
I was on Medicaid about 6 years ago. There is no reason why a doctor would ask you for money, seeing as the reason most people are on Medicaid is because they qualify as low income. I know when I was on Social Services briefly that I could barely afford to pay my phone bill, buy toilet paper and toothpaste....much less come up w/ $1500 for surgery!! LoL! You need to contact the medicaid office.
   — Dana R.

September 20, 2001
Being someone who works in the insurance field, I do know that any physician that accepts medicaid has binded into an agreement with medicaid to accept only what medicaid will pay. You should never pay anything over what medicaid pays and you should report that physician to medicaid.
   — Patricia T.