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Learn Whom Are Medicaid Providers

Jul 5, 2008
Medicaid providers are those doctor's offices, clinics, and hospitals that have agreed to accept this form of payment for services. Individuals that are approved for Medicaid are often given a list of providers so they can choose who they want to be seen by. It is important to do this early instead of waiting until you need to be seen. Most hospitals accept Medicaid so it isn't a problem. Yet doctor's offices and clinics have a set number of slots they will allow to accept this form of payment for.

In many states, you only have 60 days to choose who your provider will be. You will then need to call an 800 number to have that information added to your Medicaid card. Should you not complete this process though a provider will be assigned to you. This can be complicated to straighten out. In the mean time you will either have to see a doctor you don't want to or pay out of pocket to continue your services with your current provider.

Most Medicaid programs require you to either choose a Primary Care Physician known as a PCP or a Health Management Organization known as an HMO. In many instances though it will depend on what particular types of services are available in your area. Should your primary physician recommend that you see a specialist, you will need to get that approved by Medicaid. If you don't, there is a very good chance that you will be stuck paying those bills on your own.

Not all specialists are willing to accept Medicaid even if you are approved to see one. Make sure before you make an appointment with someone that they are going to honor the type of coverage you have. Don't wait until you show up for your appointment to discuss this issue. It can result in the treatment you need being delayed.

You do have the right to change your Medicaid provider should you choose to do so. Make sure you follow the procedure for doing so in your state. Some only require a phone call while others require something in writing before they can process such a change. Make sure you have contacted the new provide to ensure they will take you as a patient. If you have the name changed on your Medicaid card but they won't take you this isn't going to benefit you in any way.

Medicaid is a type of insurance for those that have a very low income. The program is federally funded and then independently operated by each state. One of the biggest problems with Medicaid though is finding a doctor that will accept it. Many individuals are quite frustrated to find out they are eligible for Medicaid yet they can't find a provider that accepts it in their area.

Some individuals are traveling 60 or more miles in order to find a Medicaid doctor. If this is the case the individual is often eligible for reimbursement for the cost of gas to get to these appointments. There is a set amount that is paid per mile for the trip to the doctor's office. You must have this type of reimbursement pre-approved though before you travel. Should there be a Medicaid doctor in your area available but you choose to ravel to see someone else you will be responsible for the cost of the travel on your own.

If you are struggling to find a Medicaid doctor in your area, contact your local department of human services. They should be able to provide you with a current list of providers. You will need to take some time to make some phone calls to find out who is accepting new patients with Medicaid coverage. If you aren't having any luck make sure you report that information to your local legislator. That way they can be aware of the problem and work to resolve it.

Many local agencies including human services continue to contact doctors in the area. They try to encourage them to look at accepting patients with Medicaid. They also work hard to ensure that every single doctor that does accept Medicaid is offering quality services to their patients. Just because a person isn't able to pay for the medical care out of their own pocket, they shouldn't be denied the very best of care.

Should you have any problems with a doctor that is accepting Medicaid you need to report it. Too many people are afraid to do so as they worry about being able to find another provider. If you find your bills for Medicaid aren't correct you also need to report this. There have been many cases of Medicaid fraud that have been uncovered this way.

Medicaid is a very good program that is to help those that need medical and dental coverage. In most instances, without the Medicaid they simply wouldn't be able to afford it. Therefore they wouldn't get the care they needed, especially when it comes to preventative care. One issue with Medicaid though is that it isn't always used as it should be. There are problems with fraud both from people approved for the program and by providers.

Medicaid fraud happens in many ways from the individual side of things. A person many not report all of the information on their application correctly in order to be eligible. They may end up omitting income or various household members that have a sufficient income to contribute to the household. It also occurs when someone allows another person to use their Medicaid card for services.

There are auditors in place to review charges by medical providers. They look for patterns of behavior when it comes to billing of Medicaid patients. They want to make sure they aren't billing for things that haven't occurred. They also want to make sure Medicaid patients aren't being subjected to tests that they don't need in order for them to make money.

There are also fraud hotlines where people can call in to report other people who may be getting Medicaid benefits fraudulently. A person can make such reports anonymously so that they don't have to tell anyone who they are. Generally it is friends or family members that don't feel it is right that someone is illegally getting such benefits that turn them in. Most departments of human service agencies have a fraud unit that can investigate such matters.

It is believed the Federal government is bilked out of millions of dollars annually due to the various forms of Medicaid fraud. As a result they have implemented harsh penalties for those caught to be involved in such forms of fraud. Individuals have had to repay the funds, pay a fine, and even serve jail time as part of the requirements under our justice system. The repercussions for any form of Medicaid fraud aren't going to be lenient. You can be sure the Federal government is working hard to make examples out of those they do catch.
About the Author
Ronen David is the chairman of "Malam" (an Israeli organization supporting and representing those dealing with mental disabilities). He is the author of the "How to Cope With Psychosis & Schizophrenia Self Help Handbook".
Visit his web site and learn How To Cope With Psychosis and Schizophrenia
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