11/17/2017
Charging Wellcare Medicaid Patients for Non-Covered Services
1. We are ending our Wellcare participation 1-1-18... can patients continue coming here and private pay if they don't want to change insurances 2. Can we charge Medicaid patients if they sign waiver and are willing to pay for noncovered services, whether is be a Medicaid managed care or straight Medicaid plan
A Medicaid patient can be billed as a self-pay patient, as long as their only insurance is Medicaid or a Medicaid Managed Care Plan. If a patient has primary insurance with a payer that the practice is in network with (Medicare, commercial insurance, etc.), the patient cannot be billed as a private pay patient. In order to be compliant with state guidelines for billing a Medicaid patient, the following must be documented:
- Prior to being treated by a physician, there must be a mutual agreement documented in the patient’s chart that the patient is being seen as a private pay patient. Proof should be documented for each visit and maintained in the patient’s chart.
- If the patient is enrolled in a Medicaid Managed Care plan at the time of service, they must also be given the option that they may seek in-network care with another provider for no cost. If the patient acknowledges that they are being treated by a provider that is not in network at the time and they elect to be a private pay patient, they may be billed for non-covered services.