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.
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.