Medicaid and Part B Deductible

[yabadabadoo1026]

Unless you enrolled her 1/1/15 or before you need to clarify if this isn't from when she was on original medicare and hadn't met 2015 part B deductible and also make sure the provider is billing to correct payer.

In Florida a provider who renders services to a full dual eligible are not allowed to balance bill the patient whether or not the provider accepts medicaid.Happens all the time but they are breaking a rule as a medicare provider when they do.

Like I said I put her on CIP in December, she say the dr in Dec and told her she had a 147 deductible--------I too suggested to her that any deductible prob was incurred at the beginning of 2014 and because not paid they mentioned it to her again on her 12/26 visit--------she says the bill they gave her shows the 147 with a 12/14 date so shes blaming it on CIP and plans to disenroll. I suggested if anything I was likely incurred before CIP though I though Medicaid pays that B deductible. She said the Dr bill indicated Medicaid doesn't pay it---------I told her don't work of dr bills but off E0Bs which they cant seem to trash fast enough when they come in the mail---the EOB will indicate if the 147 was paid or payable by her. We know sometimes doctors send bills to patient before they have been paid by the Medicaid to cause confusion ( and sometime they get paid twice)

Josh I cause you confusion cause I was talking Part D deductible as it related to both traditional medicare and mapd plans

 

[GreenSky]

Is it possible she either had or now had a share of cost for Medicaid? That could account for the problem.

Rick

 

[GoPokes]

Is it possible she either had or now had a share of cost for Medicaid? That could account for the problem. Rick

That would make the most sense..

 

[yogooglethis]

Like I said I put her on CIP in December, she say the dr in Dec and told her she had a 147 deductible--------I too suggested to her that any deductible prob was incurred at the beginning of 2014 and because not paid they mentioned it to her again on her 12/26 visit--------she says the bill they gave her shows the 147 with a 12/14 date so shes blaming it on CIP and plans to disenroll. I suggested if anything I was likely incurred before CIP though I though Medicaid pays that B deductible. She said the Dr bill indicated Medicaid doesn't pay it---------I told her don't work of dr bills but off E0Bs which they cant seem to trash fast enough when they come in the mail---the EOB will indicate if the 147 was paid or payable by her. We know sometimes doctors send bills to patient before they have been paid by the Medicaid to cause confusion ( and sometime they get paid twice)

Josh I cause you confusion cause I was talking Part D deductible as it related to both traditional medicare and mapd plans

I have seen many times where a medicare provider who doesn't accept medicaid ask the full dual eligible to pay the part B deductible out of pocket- which in Florida there not suppose to do but do it anyway.

 

[Bob L]

Thanks for contributing to the discussion---I'm not familiar with any MAPD plan that has a Part B deductible contained.

Yabadab, this isn't going to help you with your immediate problem at hand, but, yes, there are some MAPD's with the $147 deductible. Since the beneficiary is under the MAPD, it technically isn't a "Part B" deductible, but it mirrors it, just as most MA plans mimic 20% Part B coinsurance rates for things like Part B drugs, dialysis, and the like.

As an example, there are some Cigna-HealthSpring MAPD's in Pennsylvania and some mid-Atlantic states with these $147 deductibles. Maybe other carriers too, but the only ones I've enrolled people in are C-HS.