Forum - Questions & Answers

Mar 20th, 2012 - franco6008 1 

Can you bill Medi-Cal patients when you are not a Medi-Cal provider?

The provider I bill for is in California and does not participate with Medi-Cal. If she sees a patient with Medicare and Medi-Cal can she bill the patient the 20% not covered by Medicare? In every practice I've worked for we've always discounted the 20%. I didn't know if there was an actual rule against billing or if it was just common practice?

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Mar 20th, 2012 - Mchu 39 

re: Can you bill Medi-Cal patients when you are not a Medi-Cal provider?

I was told by Medi-Cal(I am also in California) late last year that if your doctor is not contracted with Medi-Cal then they will not pay the claim.

My doctor was on call at a hospital and delivered a baby to a patient that was on Medi-Cal(her only insurance) and they would not pay the claim, even though my doctor was on call at the hospital.

Good luck and God bless!

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Mar 20th, 2012 - franco6008 1 

re: Can you bill Medi-Cal patients when you are not a Medi-Cal provider?

Did your doctor bill the patient or did he have to write it off?

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Mar 20th, 2012 - Mchu 39 

re: Can you bill Medi-Cal patients when you are not a Medi-Cal provider?

Medi-Cal told me that I was not able to bill the patient and we had to write the balance off. I am not sure about Medi-Cal being secondary...it maybe different.

I made several calls to Medi-Cal and everytime I got the same answer basically my doctor would not be getting paid for that delivery and they kept asking if we would like to get in contract. The hospital call my doctor and because she was the OB/GYN on call for that day there was nothing that could be done, my doctor didn't have a choice not to see the patient.

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Mar 20th, 2012 - Shannan 28 

re: Can you bill Medi-Cal patients when you are not a Medi-Cal provider?

If you do not accept medi-cal then you should write off the 20%. In california if Medicare pd on the claim, even if you accepted medi-cal the remainder would be written off becuase primary pays more then the medi-cal allowed amount. Hope this helps. If you go to the Medi-Cal website at www.medi-cal.ca-gov for more info.

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