Refusing self pay

[luvboston]

Chop just called me and they said if our state Medicaid disability doesn't pay for our visit we are not allowed to self pay. Have you ever heard of this? They said it's a federal law yet MAyo is allowing us to pay 21k oop as a deposit.

[akafred]

Not sure about federal law. In my state providers are forbidden from taking self pay clients who are on Medicaid. Apparently some people will claim they will self pay but then run it through Medicaid and then Medicaid is required to pay anyway, and at the not pre-negotiated prices or whatever, putting a strain on Medicaid. So providers can't do that.

[spooko]

I don't know about the law of it all but I have also heard of this. Sorry I'm not more help!

[Deleted]

I don't have experience with this. My guess is that it is more state regulated than federal. And perhaps has to do with Medicaid. Is medicaid disability different from Medicaid medical insurance?

My other guess is that some procedures would be so expensive that it would be impossible for a family to self pay. Not sure what procedure/ visit you are having done. For example our heart surgery was 200K. I would think that would have been impossible to self pay.

Maybe like previous posters said that if Medicaid denied it they would think it unnecessary or that there would be another negotiation of price later on. Some states have laws about uninsured people at their hospital and they way the hospital has to handle their bills whether on Medicaid or not.

[mrsbuttinski]

Dec 20, 2016 18:54:15 GMT -5 luvboston said:

Chop just called me and they said if our state Medicaid disability doesn't pay for our visit we are not allowed to self pay. Have you ever heard of this? 

Sometimes it's related to the physicians' and/or hospitals contracts with Medicaid/Medicare (which forbid accepting cash from those on government insurance to accept cash payment) if the person has said coverage. 

[luvboston]

Dec 21, 2016 17:10:10 GMT -5 mrsbuttinski said:

Dec 20, 2016 18:54:15 GMT -5 luvboston said:

Chop just called me and they said if our state Medicaid disability doesn't pay for our visit we are not allowed to self pay. Have you ever heard of this? 

Sometimes it's related to the physicians' and/or hospitals contracts with Medicaid/Medicare (which forbid accepting cash from those on government insurance to accept cash payment) if the person has said coverage. 

That's the thing that makes no sense they have no contract with our state. And we didn't qualify for fed disability so the whole thing infuriates me.
There has to be a way around it. It's a freaking consult the most it could be is 1k.

[mrsbuttinski]

Dec 22, 2016 0:12:09 GMT -5 luvboston said:

Dec 21, 2016 17:10:10 GMT -5 mrsbuttinski said:

Sometimes it's related to the physicians' and/or hospitals contracts with Medicaid/Medicare (which forbid accepting cash from those on government insurance to accept cash payment) if the person has said coverage. 

That's the thing that makes no sense they have no contract with our state. And we didn't qualify for fed disability so the whole thing infuriates me.
There has to be a way around it. It's a freaking consult the most it could be is 1k.

CHOP? Do you live outside of Pennsylvania? I know they absolutely do have a contract with in-state Medicaid. I wonder if there is some sort of reciprocal agreement with other states. FWIW, even if you didn't qualify for SSI, Medicaid funding originates as primarily federal money administered by individual states.

I'm really frustrated for you. 

[akafred]

Dec 22, 2016 4:16:56 GMT -5 mrsbuttinski said:

Dec 22, 2016 0:12:09 GMT -5 luvboston said:

That's the thing that makes no sense they have no contract with our state. And we didn't qualify for fed disability so the whole thing infuriates me.
There has to be a way around it. It's a freaking consult the most it could be is 1k.

CHOP? Do you live outside of Pennsylvania? I know they absolutely do have a contract with in-state Medicaid. I wonder if there is some sort of reciprocal agreement with other states. FWIW, even if you didn't qualify for SSI, Medicaid funding originates as primarily federal money administered by individual states.

I'm really frustrated for you. 

Guessing she isn't in PA and the Medicaid is another state's. But it would still be the same situation. If they allowed OP to go to the appointment and pay OOP, but she turned around and submitted it to her insurance, her insurance would still be obligated to pay. And since they don't have a contract with her out of state Medicaid, the cost would be higher. At least, that is the logic given for our state's mandate that providers not allow Medicaid patients to self pay.

Personally I think it sucks, particularly for those not on Medicaid due to low financial means.

[luvboston]

We don't live in PA I had a huge rage with the manager. Now I'm def thinking we should just go to Mayo no matter what. They really should have told us all this before we got plane tickets and babysitters.

[akafred]

Dec 23, 2016 0:28:37 GMT -5 luvboston said:

We don't live in PA I had a huge rage with the manager. Now I'm def thinking we should just go to Mayo no matter what. They really should have told us all this before we got plane tickets and babysitters.

Yes, they should have. How infuriating!

[Deleted]

I am sorry and angry for you. Argh that sucks. I hope you can figure out something.

[di0607]

Yes this is a CHOP thing! I have yelled and screamed at them numerous times. We are in-state and my kiddo needed to have bloodwork drawn during surgery (and per ins co sent out to a specific lab affiliated with CHOP). This saga went on for DAYS... I told them I was more than happy to pay CHOP for the vein stick! It all worked out in the long run but still a major pain with them!

[luvboston]

I'm ready to just throw in the towel it's still ongoing and of course insurance is dragging its feet BC of Christmas.

[luvboston]

A miracle happened, we were approved! Thanks everyone:)

[Deleted]

That's awesome!