Dr had to drop me because I might lose my Medicaid if I continue to see him. Weird situation

[wnnipooh]

Very sad news a psychiatrist I have been seeing for like 4-5 years now had a bombshell announcement to make to me at an appointment today and I’ve never heard of this before.

I have Medicaid because I’m on SSI. His practice is not taking Medicaid but since he fits with me so incredibly well I save up the money and pay out of pocket anyway.

He explained to me that the last few months word came down from the top that any people on Medicaid whatsoever paying out of pocket for their services received a warning that Medicaid may be taken away from that individual.

Basically implying that if you can pay to see any DR out of pocket you shouldn’t be on Medicaid to begin with. This is a disaster of a situation as finding good providers and especially Psychiatrists is basically impossible on Medicaid.

So I along with many other patients have been completely thrown from the practice and it doesn’t seem there’s anything I can do. I’m still processing how wild this whole situation is.

Just wanted to share to see if anyone else has heard of this before? I really am crushed to lose such a special provider

 

[mountaintrip98]

@wnnipooh I think it's more it's illegal and that the doctor could get into huge trouble if he accepts cash payment from patients he knows have Medicaid as opposed to you getting you kicked off , but yeah, the idea is the same- the intent of Medicaid is for people that are so poor that they can't be paying cash for services.

 

[h4wk]

@mountaintrip98 Yeah the psychiatrist is definitely shady. We all wish we could get proper fees paid in cash. (The reason you can’t find anyone to take Medicaid is because the pay is shit and doesn’t pay anywhere near a market rate to cover our costs.) but everyone knows the rules, major red flag for a physician to clearly violate them for his own personal gain

 

[wnnipooh]

@mountaintrip98 He did explain that. But was saying this kind of new. They’ve been talking cash 10 years probably lol

 

[mountaintrip98]

@wnnipooh At least in my state we've had that rule for the 20 years I've been in the industry. Possible someone just brought it to his attention and told him he'd better knock it off immediately.

 

[jander8629]

@mountaintrip98 It’s been around for about 26-27 years so that makes sense.

 

[kipperbomb]

@mountaintrip98 It only violates the law in my state when the provider is Medicaid enrolled. If they aren't enrolled and don't accept Medicaid, there is no contract Medicaid can act on. There's nothing in law that penalizes people on Medicaid for paying cash for services.

 

[aleethia]

@kipperbomb This is state statute dependent. There are indeed states where it is illegal for a physician to accept cash from a Medicaid patient, even if the doctor isn't contracted with Medicaid. Kentucky and I think Colorado are examples.

https://www.dpcfrontier.com/medicaid

 

[wnnipooh]

@aleethia What about NC? The state

 

[aleethia]

@wnnipooh Looks like the author of the article wasn't able to confirm with North Carolina.

 

[aleethia]

"10A NCAC 22J . 0106(a): “A provider may refuse to accept a patient as a Medicaid patient and bill the patient as a private pay patient only if the provider informs the patient that the provider will not bill Medicaid for any services but will charge the patient for all services provided.” a. 10A NCAC 22J ."

https://files.nc.gov/ncdma/Providers_Billing_Beneficiaries.pdf

 

[seekeronsaltspring]

@wnnipooh NC just recently expanded medicaid which is probably why you are seeing the crackdown

 

[truthseeker60]

@kipperbomb This is a very important distinction in this case.

 

[alea]

@kipperbomb Same here in MD. If the provider isn’t in better with Medicaid then there is no violation.

 

[resjudicata]

@alea Actually I had a provider drop me in Maryland over a decade ago because it is illegal for them to take cash from a Medicaid patient even if they aren’t contracted with Medicaid. They were very clear it was their license on the line and no way around it even though they wanted to continue to see me.

 

[alea]

@resjudicata It’s not illegal in MD and they were wrong. I just took a CEU training on this and it was addressed and it’s a huge misconception so providers err on the side of caution. This is an issue I have with the therapy community in general. Myths spread like wildfire and people freak out and don’t do their homework.

 

[wnnipooh]

@alea Is it illegal in NC

 

[joshlete]

@wnnipooh The best way to find out is to ask your state Medicaid office directly, ideally in writing.

 

[wnnipooh]

@mountaintrip98 I guess the owner got caught or something because he’s very careful, kind of a big deal Dr(teaches at Yale) and has been doing this atleast 10 years. No I will not give name of the practice but for him to knowingly do this for this long is mind blowing

Does that mean I’m not allowed to see my therapist as well? I pay out of pocket fof them because you guessed it. Not Medicaid

 

[talitha2014]

@wnnipooh The doctor, himself, was probably just going by what someone else said he could do.