I work for the state medicaid system here in texas, and we get complaints at least (just on my calls) about 12 a day and I take on average 150 calls in an 8 hour period. That is way too many. The doctor refuses to give care or the doctor will tell them they sent authorization for a surgical procedure when they know full well that they did not. It is an ongoing cycle that the doctors find amusing and they keep doing it because medicaid only pays an allowable amount for each procedure that is rendered to the client. If they bill 150 dollars for a office visit and the state only say 32 bucks that is payment in full and they lose that money. The doctors know this when they sign up and contract with medicaid, but we have some numbskull doctors and this perpetual cylce keeps on going.
>>The doctors know this when they sign up and contract with medicaid, but we have some numbskull doctors and this perpetual cylce keeps on going.<<
Well, that sounds really good but I worked for a Psych in Cleveland who signed the contract with Medicaid because he needed his expenses covered just to drive down to the Charity hospital.
He knew that an in-patient visit was only going to pay 32.00 on his regular 80.00 fee.
For this work, he had to pay more in malpractice insurance, more for car insurance and buy a gun. (really bad neighborhood)
Medicaid delayed or turned down EVERY claim. SO while he was doing the job that no other psych on the westside of Cleveland would do, the administrative costs in reports sent and refiles ate away every cent of what he made. It was volunteer work.
This "numbskull" doctor wanted to give back to the community. He saw Adult special needs patients when no one else would and continued to see any patient who came into that emergency room at the charity hospital eventhough he was not required to by law, just give a referal. In the end, our office was going broke on these patients. I wrote up a report about how much money we were losing on Medicaid and in the end he dropped everyone but the Special needs.
Perhaps the other side of the coin is needed here.