"Illegal" to pay doctor cash instead of medicaid?!

I'm having the same issue. My fs has a medical issue and the pediatrician referred him to a specialist. Medicaid denied the referral saying it wasn't covered. I'd still like him to see the specialist just to be sure that he's okay, and am willing to pay for this but I can't as he's on medicaid. So they won't pay for it and I'm not allowed to. ??????? I feel like my hands are tied...

I was not allowed to pay for my sons flu shot, i had to wait for "medicaid" shots to arrive. i didnt have to put him on my insurance to adopt. i think its similar to daycares not being allowed to bill the parent when the state is paying.

I'm a child psychiatrist and it is also my understanding that it is illegal for Medicaid patients to pay cash. I was told by a colleague that the reason is because the Federal Government figures that if you can afford cash then you don't qualify for Medicaid, because it is supposed to be a program for people who do not have enough money to pay for medical care.

This is what I was told by our doc's office too. I wanted to pay out of pocket for a flu shot and some different antibiotics (they pay for the 14 day kind, but my kids get the 5 day kind), but I was told I had to wait on the Medicaid shots and take the abx that Medicaid paid for. It was a big pain. We have found Medicaid makes docs do more bloodwork and other tests to confirm diagnosis than our insurance does, so our FKs end up being pin cushions while my bios get real doctor experience and avoid those tests. We are debating on keeping Medicaid for future adopted kiddos for this reason.

I tried to pay for a flu shot out of pocket since the medicaid shots were out of stock. Same problem. They would not allow it. Common sense at it's best.

My son is autistic and a Regional Center client, which allows him to be on MediCal regardless of income. He doesn't qualify for behavioral services through RC because he is too cognitively advanced yet doesn't qualify for CBT or traditional therapy because giving those to a person with an autism diagnosis is forbidden under MediCal, and no, we can't self pay. So basically he's not allowed any services whatsoever to deal with his autism and comorbid emotional disabilities and psychiatric effects of epilepsy. I was advised to pay cash and pretend he doesn't have autism, but I'm thinking the flapping and rocking would give him away. That was the best suggestion his RC social worker could offer. Basically, we're out of luck. This led to a CPS investigation earlier this year which ended when they showed up at the door and said that yes, unfortunately we fall in a loophole, not a darned thing we can do, and of course it's unfounded. Common sense would indicate that this child needs help but legislation has found otherwise. There used to be a way to get kids in this loophole into county mental health through the school districts but that ended with budget cuts about five years ago, so the therapists still push the districts but they can't make any new referrals to that program. I'm looking into CBT therapists who work over skype and intend to be upfront about his autism but just self pay and not mention insurance. I haven't found one I want to go with yet but at least it's a viable option when for a while it seemed we had none. I'm also reading texts intended for behavioral and mental health professionals to sort of learn on my own. I can get through them after what I had to read for my Master's but what if I couldn't? This business with saying that MediCal kids can't pay cash and just can't go to specialists once MediCal denies the referral is nuts. It traps them in a no-win situation. I fear that Obamacare is going to make for more of these landmines for our kids. A part of me wants to be optimistic and think that somewhere in those thousands of pages is a work of genius that fixed these issues, but I have my doubts......

It is illegal for medical providers to charge different amounts based on your insurance/lack of insurance. Here is how it works. Say Walgreens charges $100 for a flu shot. (just for easy of math! LOL!) Each medical provider has a contract with various medical insurance companies. Some insurance companies pay very little compared to others, hence why some medical providers refuse to take certain type of insurance such as Medicaid. So, they LEGALLY HAVE to charge Medicaid, private insurance and Medicare the same amount. However, Medicaid may reimburse $20 for the flu shot to Walgreens and call that paid in full. Medicare may pay 10. Private insurance may pay 60. It all depends on the contract. So, by you paying out of pocket, they cannot legally charge you a different amount than they would charge the insurance company. So if a child (or adult) has insurance, whether it is private insurance or medicare/Medicaid, Walgreens or any other provider cannot accept out of pocket payment. As someone else mentioned, it is a way that providers can bilk money out of patients and still commit fraud against insurance companies.

I've paid out of pocket then been reimbursed for meds that required additional approval. My pediatrician is associated with a local hospital that takes a lot of the Medicaid patients. This hospital knows the system, so they will frequently give me treatment or meds before they have approval from Medicaid. I have private insurance now that he's adopted in addition to the Medicaid. It's amusing when the private insurance denies something, then has to pay after all when Medicaid approves it.

There is quite a bit of incorrect information on some of these threads re paying cash if you're a Medicaid patient, etc. A few people have expressed the belief that it is illegal for docs to charge different amounts to patients with different insurances, etc. That is not the case. IF you are a Medicare provider, you can't charge MEDICARE more than you are contracted to charge a private plan. I don't know if any of the private plans have similar contractual arrangements with IN-NET docs. If you are a doc, like me, who chooses to be neither a Medicare or Medicaid provider and also chooses, like me, to work OUT OF NETWORK for any insurance plan, then it is perfectly legal to charge whatever you want, just as any other merchant is free to do in any other free market.

There is quite a bit of incorrect information on some of these threads re paying cash if you're a Medicaid patient, etc. A few people have expressed the belief that it is illegal for docs to charge different amounts to patients with different insurances, etc. That is not the case. IF you are a Medicare provider, you can't charge MEDICARE more than you are contracted to charge a private plan. I don't know if any of the private plans have similar contractual arrangements with IN-NET docs. If you are a doc, like me, who chooses to be neither a Medicare or Medicaid provider and also chooses, like me, to work OUT OF NETWORK for any insurance plan, then it is perfectly legal to charge whatever you want, just as any other merchant is free to do in any other free market.

Yes, this is exactly what our pediatrician told me. I wanted to use her for our little guy and pay cash since she doesn't take Medicaid. She also told me it was illegal and is considered Medicaid fraud.

We have run into this before. There was some testing a psych wanted to do and it was more then what Medicaid would approve. I said, "Fine, how much does it costs?" He said it was illegal for me to pay out of pocket for the tests. Sometimes I hate Medicaid. The worst thing lately has been getting Medicaid to cover copays. We have private insurance on top of Medicaid. We aren't required to do so, but sometimes they get better care with the private insurance. We also carry dental and vision on top of Medicaid. The new vision insurance has co-pays that our prior vision insurance did not have. If they only had Medicaid it would pay 100% of exams and glasses. Apparently, it won't pay for co-pays, so exams and glasses are going to cost us about 75.00 per child. This is on top of the annual cost of the insurance. Next year we will probably cancel the vision insurance, save a couple hundred dollars a year, and save the cost of the co-pays. It will cost Medicaid more because they will have to pay the full cost of the kids glasses and exams, but apparently they would rather do that then pick up the co-pays. Just stupid!

And that is how it has always worked for me. If your health care provider takes Medicaid, they MUST bill medicaid according to the contract terms(which means no billing extra to the patient, or not billing the medicaid at all). If your health care provider does not have a contract with Medicaid, they may refuse you for any excuse they want to come up with...or treat you like any other cash patient. When my bio kids were on Medicaid, I had zero issue with taking them to our regular doc(who did not accept medicaid), and paying cash. Same for the dentist. For our foster child, there was NO flipping way I was taking him to the puky nasty shady as heck medicaid dentist...no prob, we paid cash to our dentist who doesnt accept medicaid. For the eye doc, I wouldnt use medicaid, because ours only has the ugliest glasses for the kids to wear...and have like 4-5 frames to choose from. And the only clinic nearby who takes medicaid will only see medicaid patients one day/mo & you sit around waiting hours to be seen, first come first served. Very demeaning, imo.

Even if the provider is not contracted with Medicaid as a Medicaid provider, it is still illegal on both provider and patient's part to pay/accept cash, as far as I know.

So, our chiropractor takes insurance, but not medicaid - so I pay out of pocket. Thats illegal?? If so, its insane. My boys NEED regular adjustments to stay healthy.