Medical Collections – Medicaid

[webiweave]

I need some advice from people who know about medical collections and Medicaid.

I have Medicaid but it has limited procedures that it will pay for. Between February and May 2009, I had 2 ER visits, a surgery, and numerous doctor visits. I now have 2 companies trying to collect on those medical bills. The ER and the doctor’s office made me sign paperwork before they would treat me. I was told that it was so that they could bill my Medicaid and if I didn’t sign it then they would not treat me. I was in a lot of pain at the time and I don’t remember what the papers said. I requested copies of all of the paperwork, but the pages I signed were not included in the copies.

The first company is trying to collect on the first ER visit on 2/19/09 – Medicaid paid on part of the items. From what I can tell, the ER did not send in a claim for the procedures that they knew Medicaid would not pay for.

The second company is trying to collect on the doctor bills. The doctor’s office also did not send in claims on the stuff that they knew Medicaid would not pay for.

I sent the validation request along with a cease and desist for the phone calls. The collection companies sent billing statements from the original companies - with just the procedure codes and amounts so I am not even sure what I am being billed for. I called Medicaid and had them send me a copy of the claims they received- only 4 claims and they paid on those claims. So here are my questions:

1. If they failed to bill Medicaid, am I still responsible for the charges?

2. From my understanding, I am only responsible for the amount allowed by Medicaid, not the full amount charged. Is that correct?

3. For medical collections, does the 3 year SOL apply or is it longer?

Any suggestions on how I should proceed with the collection companies? Thanks in advance for the help.

[Guest usctrojanalum]

1. If they failed to bill Medicaid, am I still responsible for the charges?

If you had an active medicaid that would have covered the charges, you would not be responsible for them. Do you have a social worker? Or someone else who can represent you to handle this.

2. From my understanding, I am only responsible for the amount allowed by Medicaid, not the full amount charged. Is that correct?

This is dependent if you were covered or not, if you were not covered they can charge you the full amount of the visit at the self pay rate.

3. For medical collections, does the 3 year SOL apply or is it longer?

Unless your state law says otherwise, medical collections typically falls under contracts wrt to SOL.

[VADebtor]

On the question of being able to bill only the Medicaid allowable charges...

A friend has Maryland Medicaid, which is made available through an HMO structure. After becoming covered but before (and after) her first doctor's appointment (giant delays in getting appointments) she had what were diagnosed as MRSA infections and three or more ER visits.

The Medicaid HMO says they don't cover ER - but they provided no means of being seen. The ER also plays a game where they bill for the ER, and a separate medical practice (controlled by the same entity as the hospital) bills for physician services.

I believe they should write this off to charity care, or file for Medicaid reimbursement and appeal the denial due to the urgent nature of the problem. But if they won't do either of those, would they be limited to the Medicaid allowable amounts?

[Guest usctrojanalum]

Tell your friend to fill out an application for charity care as soon as she can, that might give her even bigger breaks than the medicaid rate.

The problem with paying a contractual rate when you don't have insurance coverage, is just it's not really fair. If hospitals allowed people who are not covered by an insurance to pay a contractual rate (be it any rate, medicaid, bcbs, vytra), why would anyone buy insurance?

[Credithis]

I have lived in Arkansas and my Wife is from Arkansas. Arkansas has a two year SOL for medical debts.

STATUTE OF LIMITATIONS (IN YEARS)

Open Account: 3 (except medical which is 2 years)

Written Contract: 5 (partial payment stops the statute from running)

Sale of Goods (UCC-2): 4

Domestic Judgment: 10 renewable

Foreign Judgment: 10