weird hospital issue..

lysdenholm

Hi guys, I'm a newb...with that being said...I called the obgyn I had used for my last pregnancy today. The receptionist was really nice..until she asked if we still had blue cross..which I don't, so I told her I'm  filling out my medicaid stuff tomorrow (I only found out I was pregnant friday!! thought I was ahead of the game)..then she gets quiet and asks me my last MP and tells me my EDD is in May and they are booked for may. Weird thing is...I only had my son last year(2012) and I don't remember there ever being a limit, and I transfered from somewhere else at 17 weeks!..they even have a new Dr, making a total of 7!! My friend had her daughter there last month, and doesn't remember a limit either. I really felt it was because of the medicaid..I dont know what I'm going to do now.. I live in a very rural area, and these guys were an hr away!! what should I do? they can discriminate because of the insurance..right?

starskristen79

I think they do have the right to take some insurance and not others. My Dh's old primary doc doesn't take insurance at all anymore, he works on a retainer!

lysdenholm

I was really upset..the house we have been looking and did all of our loan stuff for got bought saturday..the day after I found out. Now this, I cant even see my same doctor..and I'm super emotional so I'm panicking..I don't know what I'm going to do

lysdenholm

they do take medicaid, its on their site..and my friend that was just there has medicaid

mrsbtobe20122

kitchencolors said:

A lot of providers put limits on the numbers of Medicaid and Medicare patients they will maintain at one time. Their reimbursement rates are significantly lower for these patients, so they keep a cap for financial reasons.

Re-read this. Some providers also limit Tricare.

MommyDay2be

This was a problem my first PG. unfortunately there is a limit most providers have for Medicaid. And believe it or not the treatment plan is different as well. For example, most docs won't give you a vaginal US when you have Medicaid. I didn't get any kind of US at all till I was 22 weeks! Hang in there. Do some looking around and make sure you still get a good doctor. If you can find a midwife. A lot of times they accept more insurance and I think they are much more comforting

Junebug060609

mrsbtobe20122 said:

A lot of providers put limits on the numbers of Medicaid and Medicare patients they will maintain at one time. Their reimbursement rates are significantly lower for these patients, so they keep a cap for financial reasons.

Re-read this. Some providers also limit Tricare.

This.  I haven't run into my Tricare being an issue with my providers, but given how Tricare only allows them to charge a fraction of their retail costs I can see why they'd limit us.  I'd imagine Medicaid would have a similar arrangement.

mrsbtobe20122

Junebug060609 said:

mrsbtobe20122 said:

kitchencolors said:

A lot of providers put limits on the numbers of Medicaid and Medicare patients they will maintain at one time. Their reimbursement rates are significantly lower for these patients, so they keep a cap for financial reasons.

Re-read this. Some providers also limit Tricare.

This.  I haven't run into my Tricare being an issue with my providers, but given how Tricare only allows them to charge a fraction of their retail costs I can see why they'd limit us.  I'd imagine Medicaid would have a similar arrangement.


The clinic I go to doesn't accept it all, which is unfortunate.

Unknown

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chargers32

I'm sorry that really stinks that you can't see the same doc.
I wasn't aware of docs regulating how many people they see on medicaid

MeredithElese

MommyDay2be said:

Do some looking around and make sure you still get a good doctor. If you can find a midwife. A lot of times they accept more insurance and I think they are much more comforting

This. One of my BFF's was on Medicaid with her first while she was in grad school. She found good support from a midwife that delivered at a hospital.

MMason12

kitchencolors said:

A lot of providers put limits on the numbers of Medicaid and Medicare patients they will maintain at one time. Their reimbursement rates are significantly lower for these patients, so they keep a cap for financial reasons.

PP got it right. It is 100% up to the doctors to decide which insurance providers and networks they are going to accept for payment purposes.  Almost every doctor limits the number of Medicaid/Medicare patients they will take on at a time, due to the low reimbursement rates, which just getting reduced further making the problem even worse -- if they even accept Medicaid/Medicare patients at all. The rates have gotten so low that there are a lot of doctors who just have begun to refuse Medicare/Medicaid patients because they can maintain a heavy caseload without them. 

I can almost guarantee you their Medicaid case load for May is already full which is why they will not see you. It may be a challenge to find a provider who will accept Medicaid, but do not wait any longer to start searching. The longer you wait the more patients they already have for May and you could find yourself in a revolving door problem. 

flutepharm87

I know insurance is hard to understand, but with Medicaid, the patient generally pays no  or little money as a co-pay. Whatever Medicaid feels is fair for the service, the provider has to accept it as full payment for the service. With normal insurance, whatever the insurance doesn't pay for, the provider has the option of billing the patient for reimbursement. 

What the means is this: A service, say an u/s, costs the provider $100 to perform. Regular insurance (say, a 20% coinsurance plan) means that the insurance pays the provider $80 and the patient pays $20 for a total cost of $100 paid to the provider. With Medicaid, Medicaid decides to pay $80 and the patient pays nothing. This means the provider LOST $20 giving that patient an u/s.

There will always be clinics that cannot turn away Medicaid patients. Usually, these are clinics that receive a lot of funding by the government. However, private practices do NOT have to accept Medicaid, even at all. Some offices will limit the number of patients in the practice with Medicaid. Others, like my old OB, will only accept Medicaid if you were an existing patient with normal insurance that gets Medicaid later on. If everyone always accepted Medicaid, the doctors offices wouldn't make any money and couldn't stay in business.

It's really unfortunate that your choices are limited with receiving state assistance. I had to deal with it for my last pregnancy and the lack of provider choice is frustrating as hell. However, this is one of those things you have to deal with when you don't pay for your own coverage.