Out Of State Insurance Issue (Medicaid)

[Savas]

I'm a NYC resident. I was visiting friends in NJ when I suffered a gall bladder attack and was taken by ambulance to a local New Jersey hospital. I suggested in the E.R. that I be transferred to a NYC hospital because of potential insurance issues (the hospital, Palisades, is on the river, a 5 minute trip).

They said there wouldn't be a problem with the insurance coverage. I demanded they call my Medicaid provider to confirm coverage, which they stated they did and everything was taken care of.

I called medicaid to confirm they picked up the cost of the surgery and hospital stay.

However, the anesthesiologist contacted me about billing for his services. I informed him that medicaid (NY) requires that any service be billed directly to them. I offered to give them the phone number to contact medicaid to deal with billing.

They stated they don't deal with NY medicaid and can't bill them. I called medicaid and they told me to inform the anesthesiologist's office to submit a claim (which I got the impression they would accept and pay out accordingly).

The anesthesiologist again said they couldn't do that and didn't know how.

My worry is this; I beleive medicaid requires billing to be done in a prompt manner (one month?) for claims to be paid out on. Anything past that is denied.

I don't see why I should get stuck with a bill because this office refuses to make any attempt to submit a claim to NY Medicaid.

I also have no way of contacting this office; I've tried calling the hospital and have had no luck finding out there phone  number to warn them on this matter.

Am I responsible for this bill if this office fails to collect from medicaid due to their own refusal to attempt to bill my insurance in a timely fashion?

[Amir Mostafaie]

Dear Savas,

The hospital where you had your treatment should have your Anesthesiologist’s name & contact information. If they can just provide you with his full name, you can use a search engine like Google & find his contact information.
Unfortunately any provider who is not directly contracted with your insurance carrier could come after you for payment but based on the information you have provided, the following steps may help you;
- Contact Medicaid & ask them how an out of network provider/doctor can file claims.
- After you get that information, reach out to the Anesthesiologist in writing (with registered mail) & advise them that your insurance provider (in this case Medicaid) has requested to be billed ASAP & provide them with what they need to bill Medicaid.
- In your communication with the Anesthesiologist, advise them that you feel like you have done everything in your power to facilitate payment & delayed billing or not billing the appropriate office may result in not getting reimbursed for their services.

Document everything including the number of times you communicate with the hospital, doctor & Medicaid including time of the day & the person you speak with & if you talk to the Anesthesiologist ask him for his email address so you can communicate with him in writing.

Wish you best of luck.

Sincerely,

Amir Mostafaie

[Savas]

Thanks, I'd begun to come to the conclusion I was reaching the certified letter stage. It's good to receive confirmation.