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Medicaid covers chiropractor appts. My disabled child just started to receive medicaid, his main doctor is a chiropractor. If I submit my chiropractor bills to medicaid, how much do they cover, and where should I mail the bills?
Watch out. Although I am not familiar with medicaid, I do know that medicare and most insurances have strict restrictions as to what they will pay chiropractors for - often only a specific maximum number of spinal adjustments a year. Call your medicaid office and ask what their rules are. Most health insurance cards have the appropriate phone numbers on the back of the card. You will be responsible for the balance.
Unfortunately many chiropractors and other health care providers have taken seminars on improving their income schemes. When a doctor will not bill insurance directly, they often know some of their treatment will not be covered. This does not mean that the treatment is not effective for that particular patient. It is part of the problem of having a third party paying the bills.
When I worked in a medical office, we were required to submit charges directly to Medicaid, and we were prohibited from billing the patient for any charges not covered by Medicaid. I do not believe that the rules have changed. This chiropractor may not participate with Medicaid because of the low reimbursement rates, often in the neighborhood of 30% of charges. You either need to find a new provider who does participate or plan on paying 100% of the charges yourself.
I agree with everyone here... I have a disabled son on Medicaid. I've never had to directly submit bills; I just show my insurance card and his Medicaid card when he has an appointment and he pays his co-pay ($3.00).
I've also never heard of a chiropractor being anyone's main doctor, though. Is he on Medicaid through a waiver, such as the Ill and Handicapped waiver? If he is, he should have a case manager or care coordinator who should be able to help you find answers. You might want to call Medicaid directly. If this is a scam, you could be out lots of money. Hopefully, it is not a scam, but the doctor should submit the bills directly to Medicaid. Good luck!
I use a chiropractor, and the co-pay with Medicare is $8.22 because Tricare for Life (military benefits) do not cover chiropractors. The chiropractor submits to Medicare, but with Medicaid they might have different rules, so you need to check with them, not us.
Another caustic answer from Ferris. This is getting old. OP, you are part of this community and you can, of course, run things by us. Now, to your question. If a provider accepts medicaid, they must submit their own bill to medicaid and they cannot charge you for the difference. If the provider does not accept medicaid then you have to pay them yourself, cash. Often, doctors will work with you for a discounted rate when you're paying cash. That's up to them. If I were you, I'd just get a doctor that accepts medicaid. The chiropractor you mentioned does not sound very accommodating. Good luck.
Call your doctor's office and ask to speak to the billing department. Ask them why they don't submit the claims to Medicaid. They should be able to give you an answer. It does happen sometimes that doctors don't bill directly, but 99% of them do, and if there is another doctor in your area that does, I would advise using their services instead of this one…unless you feel some kind of crazy special juju about this one. Just because he doesn't submit your claims for you doesn't mean he's not legit, but that said, if he was legit, he shouldn't have any problems doing the paperwork that goes with it. If he accepts medicaid, then all he is allowed to bill for is your copay. If you submit claims to be reimbursed after paying out of pocket, it will be exceedingly difficult to get your money back. @Christine…easy on Ferris, huh? Just because she doesn't sugar coat it doesn't mean she not right :) None of us sea lawyers have all the right answers, but if we have experience we can sometimes ballpark it. Hope your day goes better.
You should find out from Medicaid a few things: 1.) If your disabled son needs a primary care physician & if he is allowed to just have a chiropractor without a medical doctor. 2.) If Medicaid covers chiropractic visits AT ALL, and if they do, exactly what treatment they will pay for. 3.) If the chiropractor is a participating Medicaid provider. 4.) What your responsibility for the treatment is, i.e. if you have a co-pay, etc.
Medicaid benefits for chiropractic differ greatly from state to state. I know that Medicare/Medicaid has been changing the reimbursements for chiropractic drastically in the last couple of years. If your son's chiropractor is a participating Medicaid provider, then he/she is required to submit the charges directly to Medicaid. What you're describing sounds like the chiropractor is not a participating provider, you have to pay for the visit & you can apply to Medicaid to be reimbursed for the visit. That question is simple for the chiropractor's office to answer for you.
Just curious----why is a chiropractor your disabled son's main doctor? You don't say what the disability is. I'm just wondering why you made that decision.
The doctor's office should bill Medicaid directly. I agree with 'TooYoung'. It sounds like your child's Chiro is not a Medicaid contracted provider.
Florida M/C probably sent you a stack of information - but you may want to visit their website at myflfamilies/service-programs/access-florida-food-medical-assistance-cash/medicaid
But I would like to draw your attention to the following excerpt from the above page:
"Children's Medical Services (CMS) believes that every child should have a primary care doctor who serves as that child's medical home. Children with special health care needs specifically need a primary care doctor. "
My nephew is on Medicaid and must use Medicaid doctors. This doctor, if not medicaid approved, should not have taken any money from u. If he is asking u to submit, this is a problem. If he is not a medicaid provider, he shouldn't have seen u. When medicaid excepted u, you were asked to pick a provider from a list. Same with medical and perscriptions. I have a feeling u will be paying this out of pocket.
Get your son a primary care physician and a chiropractor that accepts Medicaid. Doctors who accept Medicaid know to bill directly and cannot ask patient to pay upfront.
No medicaid provider will ask you to bill. It is not legal for them to do so. I am sorry but this doctor is running a scam on you. I worked for a chiropractor for a few years and while i do think they can benefit people i also know first hand what they are taught at their seminars and it would sicken people to know the scams they are taught to run. Make sure if you chose one they dont get you in a cycle of everyday then 3 times a week for 8 weeks, this is typical set up for patients especially if they are billing an auto ins company after accident. Just be careful!
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Unfortunately many chiropractors and other health care providers have taken seminars on improving their income schemes. When a doctor will not bill insurance directly, they often know some of their treatment will not be covered. This does not mean that the treatment is not effective for that particular patient. It is part of the problem of having a third party paying the bills.
I've also never heard of a chiropractor being anyone's main doctor, though. Is he on Medicaid through a waiver, such as the Ill and Handicapped waiver? If he is, he should have a case manager or care coordinator who should be able to help you find answers. You might want to call Medicaid directly. If this is a scam, you could be out lots of money. Hopefully, it is not a scam, but the doctor should submit the bills directly to Medicaid. Good luck!
1.) If your disabled son needs a primary care physician & if he is allowed to just have a chiropractor without a medical doctor.
2.) If Medicaid covers chiropractic visits AT ALL, and if they do, exactly what treatment they will pay for.
3.) If the chiropractor is a participating Medicaid provider.
4.) What your responsibility for the treatment is, i.e. if you have a co-pay, etc.
Medicaid benefits for chiropractic differ greatly from state to state. I know that Medicare/Medicaid has been changing the reimbursements for chiropractic drastically in the last couple of years. If your son's chiropractor is a participating Medicaid provider, then he/she is required to submit the charges directly to Medicaid. What you're describing sounds like the chiropractor is not a participating provider, you have to pay for the visit & you can apply to Medicaid to be reimbursed for the visit. That question is simple for the chiropractor's office to answer for you.
Just curious----why is a chiropractor your disabled son's main doctor? You don't say what the disability is. I'm just wondering why you made that decision.
Florida M/C probably sent you a stack of information - but you may want to visit their website at myflfamilies/service-programs/access-florida-food-medical-assistance-cash/medicaid
They also provide Case Management for children with disabilities:
http://www.floridahealth.gov/AlternateSites/CMS-Kids/families/families.html
But I would like to draw your attention to the following excerpt from the above page:
"Children's Medical Services (CMS) believes that every child should have a primary care doctor who serves as that child's medical home. Children with special health care needs specifically need a primary care doctor. "
I suggest you contact their office. Good luck.