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I’m Covered By Medicaid But My Doctor is Suing Me For The Bill. – Laura

“Dear Steve,

I live in new york state, have an income below the federal poverty level, and recieve medicaid benefits.

9 months ago, when i was pregnant (approximately 3 weeks before my due date,) I visited new jersey. when i was there i began hemmoraging. i went to the nearest emergency room, was admitted and recieved treatment.

this hospital (and presumable its on call physicians?) particiapates in the new jersey medicaid program.

i submitted my nys medicaid information when i was admitted, and because this was a medical emergency, my new york medicaid agreed to pay for all medical bills for my treatment.

the hospital has already submitted its bill to medicaid and been paid.

the on call doctor refuses to bill medicaid, even though a representative from my managed care provider has called them and told them exactly where to submit the bill, and told them that their bill has already been pre authorized, they simply need to submit it.

the doctor is now suing me in new jersey civil court.

the representative from my managed care provider told me that it is illegal to bill a patient for a service that is covered by medicaid, but i am totally out of my depth here and i am completely at a loss as to how to proceed. I really have no idea how to find the relevant laws, and how to use them to defend myself in court.

Laura”

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The Answer

Dear Laura,

That sounds like a horrible experience by the doctor. I agree, the doctors office should know better.

You might want to first summon up all the patience you can and call New Jersey Medicaid Fraud and Abuse Hotline: Doctors, Pharmacies, Clients and Other Providers to report Medicaid, PAAD and GA Fraud and Abuse 1-888-937-2835 or 1-888-692-2140

You can also find the number and email here for the Medicaid assistance center that is in the area this all happened near in New Jersey and call them.

It sounds like you have someone on your side with the benefits provider in New York. If you can use the information above to locate the person in New Jersey that can help resolve this problem, and then connect them together, it might take care of this unfortunate situation quickly.

Lastly, contact your local Legal Aid center. They may be able to provide you with specific legal advice at no cost to you. I’d give you a link if I knew what part of the state you lived in.

Please post your responses and follow-up messages to me on this in the comments section below.

Big Hug!

Im Covered By Medicaid But My Doctor is Suing Me For The Bill.   Laura
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About Steve Rhode

Steve Rhode
Steve Rhode is the Get Out of Debt Guy and has been helping good people with bad debt problems since 1994. You can learn more about Steve, here.
  • laura

    this is the person who asked the question, posting a follow up in case others find themselves in the same boat.

    this is actually a very peculiar situation to be in. ew jersey medicaid was not able to help me as i have new york medicaid. medicaid is a state run program, so they dont intervene in out of state claims.

    I called several different offices of new york medicaid, and they all told me that if the doctor does not submit a bill there is nothing they can do about it. everyone i spoke to seemed very puzzled, as to why a doctor would choose to sue, when they could just bill medicaid and get paid. federal law does require that a managed care organization hold the member harmless against this type of claim, so the managed care organization must pay the doctor enough so that they do not come after the patient. of course they cannot do this if the doctor refuses to bill the managed care organization….

    the basic assumption is that when a patient seeks medical care an implied contract exists between doctor and patient, a meeting of the minds, and implied agreement that the patient will pay for services rendered. i planned to go to court arguing that no implied contract exists between medicaid patient and emergency services provider. a medicaid benificiary knows that when they recieve emergency care, medicaid will cover all costs, and federal law states that a medicaid benificiary is not liable for any charges relating to emergency care. 

    i filed my response with court, prepared for trial, and ultimately, 3 days before trial they dismissed the case. i suspect this was all an elaborate game of chicken, they wanted to scare me, make me afraid of ruing my credit score by getting a judgement, and decide to pay them to just make it stop. 

    if you are a medicaid patient going through something similar hang in there, i kow it is stressful, but really you will be ok. you have rights, and if you read through the code of federal regulations and us code, you will find all you need.

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