homebirth backup doctor and insurance fraud?

[mrsrayray]

There is a homebirth friendly doctor in town who I was supposed to have a few prenatal visits with, just as a backup doctor. I called today to make an appointment, planning to pay out of pocket. The problem is that once they heard that I have medicaid insurance, they won't accept me as a patient, even though I'm paying cash.

It doesn't make any sense to me, and someone mentioned something about it being insurance fraud. It seems silly though, if I lied and said I had no insurance at all, they would accept me as a cash patient. What's going on here?

[2011mama]

That is very odd. I don't have any answers for you either. I'm not understanding how it would be fraud though but it does seem very unfair! And it does not make sense. They could probably get more out of you as a cash patient than they would from insurance so why they are turning you down makes no sense. Maybe try calling again in a bit and hope you get someone else and just say you will be a cash patient? Does your midwife have any recommendations on how to handle this? I'm assuming she is who recommended the back-up doctor but of course I could be way off base here. So sorry you have to deal with this.

[mwherbs]

Probably depends on the state administering it. i did a google search
"billing medicaid patients rules". And got a couple of state answers one spelled out how a patient is to be billed if the doc does not accept medicaid, so some places it is possible.
Maybe what you can do is call again and say you have no insurance... Maybe you will get an appointment.

[mrsrayray]

I think if I tell them I have no insurance, they'd take me on. I'm just wondering if that would get ME in trouble. I talked to my midwife again and she told me of another doctor an hour away who will take medicaid, in which case I'll be spending $20 on gas for the appointments but I'll be saving the out-of-pocket fee for the appointment. :p 

I'd think they'd be happy to have a patient paying out of pocket, no matter what insurance they're covered by. Argh :p

[womenswisdom]

A medicaid provider is not allowed to accept cash payments from a patient who has medicaid. Even though this doc no longer takes medicaid, he is still on their provider rolls, so he cannot take cash payment from you if you have medicaid (I happen to know who you're talking about . For HIM, it would be insurance fraud to do that, because it's illegal. That's what's going on. I don't know whether you would get into trouble or not, but that's why his office can't take cash payments from you.

[mrsrayray]

hmm weird. So it's a matter of medicaid needing to update their list so he's not on it? and then he'll be able to take cash? Alrighty makes sense. :p Meanwhile, I'll be journeying to dayton. :p

[AlexisT]

It depends on the state. I was told that in some states, if you are providing a Medicaid covered service, that by accepting a Medicaid patient you are agreeing to accept what Medicaid pays for that service, even if you're not normally a Medicaid provider. You can't charge them cash price. This is meant to protect patients (e.g. you go into the hospital, you get whoever's available, you can't be billed for it) but it can cause inconveniences. I did not hear that from Medicaid, though; it's what someone I know was told by her pediatrician's office. I would guess that you'd need to call Medicaid in your state to find out their billing rules.