Question:
Is it legal for Gov Pay patients to be required to pay more $$$ to the Dr.???

After a year and a half of fighting Voc Rehab, I finally get paid. I get seen by a great experienced Dr who tells me that as of the first of 2002, he is requiring an additional $500-$700 from patients receiving GOV PAY programs such as Medicaid and Voc Rehab. This money has to be paid upfront before the surgery datre will ever be issued. Is this legal? My coulselor says not and is checking into. This Dr. is one of the most experienced in the state probably and does wonderful work, but if I had that type of money, I wouldn't need government subsidies.    — Wesley M. (posted on March 28, 2002)

March 27, 2002
no they cannot do that..if they accept medicaid or medical assistance they have a contract with the govt to accept the assigned amount for their services. It is illegal for them to ask for above and beyond that.
   — paula B.

March 27, 2002
Many surgeons require a fee in addition to what insurance will pay, and characterize the fee as being for the post-op counseling and follow-up program (hence, they usually call it a program fee). Many surgeons do not. What may be questionable is having a specific policy that some patients are required to pay it, and some are not. On the other hand, I know hospitals charge self-pay patients a completely different price for services than they charge insured patients, and that seems to be legal... You may want to consult with a doctor who does not charge a program fee.
   — kateseidel

March 28, 2002
I don't know about voc rehab but I'd suggest you contact your local Health & Welfare Office. At least in WA & ID (and I'm assuming probably everywhere else) if they accept Medicaid they have to accept what Medicaid pays as payment in full - period. I believe its a breech of contract and I think your state will be more than happy to step in and set things straight. Another thought though, there are a lot of us having to self-pay out here who'd give ANYTHING to have to pay only $500 to get our surgery (and no I'm not rich at all). If you don't want to get on their bad side until after the surgery maybe you could wait and push the issue after surgery and hope for reimbursement? For now could you borrow that money, or put in on a credit card, or anything?
   — Shelly S.