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

[jander8629]

@poseyka Balanced budget act in 1997.

 

[wnnipooh]

@poseyka That’s crazy to me. I know so many practices like therapists for instance who absolutely do not take Medicaid. But absolutely see you for out of pocket

 

[elizabethc]

@poseyka

I think your provider just got warned finally so now he’s gonna comply.

How would the provider know if the patient had Medicaid if the provider doesn't even take Medicaid?

 

[poseyka]

@elizabethc Basically would rely on the patient telling them. Often times providers have forms a patient fills out that ask too

 

[jander8629]

@wnnipooh About 26 or 27 years.

 

[wnnipooh]

@jander8629 Is there a link to the law you could give me

 

[erinmarie00]

@wnnipooh This is true about Medicaid and as far as I know, has been for a while. There has been a push for more transparency in healthcare billing this year, which is probably why they're just now handling it. We're coming off the pandemic, in which insurance companies allowed many things to slide, but they are tightening their restrictions again.
Sorry OP I disagree with the reasoning because when someone on Medicaid is paying out of pocket for something, it's because the service or level of service isn't available to them so they must. They're not typically doing it because they can afford to. Most specialists do not take Medicaid, therefore you're stuck between a rock and a hard place. And the reason most specialists do not take Medicaid is because they're taking a loss, because Medicaid does not reimburse the cost of what it takes to see their patients.

 

[wnnipooh]

@erinmarie00 Exactly. Thank you for understanding how hard this is. Heartbreaking for people in much worse shape than me atleats I’m kind of stable right now

 

[1stbrownhorse]

@wnnipooh If you pay cash how does the government know you went to a therapist?

 

[smallcrabs12]

@1stbrownhorse The provider must have a Medicaid or Medicare contract and got audited.

 

[aimfortruth]

@wnnipooh Yes I’ve had this happen to me. It’s technically considered insurance fraud. I tried to go to a planned parenthood for my bc injection and was on Medicaid. They didn’t take the version I was on, so I asked about paying out of pocket. This was back in 2021 and I had gone before when I wasn’t on Medicaid. My income allowed Title X to pay for my visit and medication. I asked the receptionist about it and she said “yes that’s true but because you have insurance it will still be considered fraud even if you don’t pay yourself.” It absolutely sucks and I’m so so sorry.

They’re cracking down even harder on medication too, I have chronic pain and Medicaid doesn’t cover my as needed opioid prescription. The pharmacy threw a hissy fit when I tried to put goodrx on the prescription after the prior auth denial. Like if I’m on Medicaid and they won’t cover a medication, why do they think I can pay $40 for a medication? When goodrx lets me get it for $12?