I have recently been informed that when I was on Medicaid, it was MY responsibility (as the patient) to make sure that the provider billed Medicaid properly. Is this so?

by S.M.G.
(GEORGIA)

I was on Medicaid last year, pregnant & had a miscarriage. During an E.R. visit, while still on Medicaid, the local hospital failed to file Medicaid properly & has filed a suit against me stating that it was my responsibility to ensure that they filed properly and the remaining bill is mine to pay.

I find this to be unfair & unjust. I do not find it to be my "job" to make sure that others that are hired to be 'medical billing professionals' do the job that they are trained to do. My question is, is it in fact the responsibility of the patient to make sure that the billing dept of whatever facility/doctor's office that is seen does in fact bill Medicaid properly or otherwise is responsible for the remaining balance?

Response:

Sorry to hear about all the trouble you’ve had to deal with.

Hospitals and providers typically state that they will file insurance claims on behalf of the patient but that the patient is ultimately responsible for payment. It’s the patients responsibility to provide accurate insurance information - but they usually make a copy of the insurance card. It almost sounds like the billers didn’t really make any effort to follow up on the unpaid or denied claim.

The provider is contractually required to accept the insurance payment, write off what is not covered, and bill the patient for their responsible amount. For Medicaid this is typically not a high patient responsibility.

But in your situation it doesn’t sound like there was much of an effort on their part to follow up on the claim with Medicaid or yourself. If the claim is denied its many times because there’s errors in the insurance ID, or date of birth, or spelling of the name. These are usually easy to fix and just re-submit the claim. We usually send statements (depending on the provider) with notice that the claim was denied, and to contact us about it.

I would recommend getting some legal advise on this. Here’s a good site for info on getting legal aid in Georgia. They also have information on the site about getting free legal advice.

I surprised they are already taking legal action against you. I think if you had some legal protection it would really help resolve the situation.

You may also want to call Medicaid - or the state agency that administers it - and see if they have any record of the hospital filing claims on your behalf. If so you could see why they didn’t pay it. A lot of times when we get a bill from our provider, I’ll just call our insurance company and see why it wasn’t paid. I can get a lot more info than from talking to the provider or hospital. Not long ago I had a hospital stay and we received a huge bill from the hospital. Turns out they made a mistake in filing the claim. But it took a few phone calls to resolve and get them to re-file.

Hope this helps some