Additional resources provided by the author
1. Hospitals practice “balance billing.”
Balance billing occurs when a hospital or other health care provider receives money from Medicare or Medicaid and then attempts to bill you or your family for the difference. In other words, the health care provider wants to “have its cake and eat it too.” The practice is illegal but that does not stop some health care providers.
Although health care providers cannot practice balance billing, they can forego payment from Medicaid either until the automobile claim is resolved or one year passes. If they do not make a claim within the one year (364 day) time period, their Medicaid claim will turn into a pumpkin and be lost forever. This is a risk most health care providers are not willing to take. Even if your claim does settle before the one year and the health insurance provider stand there with its liver spotted hand out, you can still negotiate a final settlement on the bill.
2. They refuse to accept your Medicare or Medicaid.
Many types of treatment are simply not covered by either Medicare or Medicaid. For example, chiropractic care and acupuncture are not considered “traditional” medical treatment and Medicare and Medicaid do not usually cover this type of treatment. Unfortunately, these governmental health care programs would rather pay for opioids to treat your symptoms.
If your health care provider refuses to submit your bill to Medicaid, they are assuming the risk that your claim will be successful and you will receive funds. However, as explained above, you are free to negotiate your bill with that health care provider. Not only are health care providers generally risk adverse, they often do not do as well negotiating with me as they do by just accepting payment from Medicaid. I generally insist on the health care provider taking a reduction for attorney fees and costs that are commensurate with the amount they are billing. In addition, I reduce the amount owed by a percentage of funds that will need to be paid for future care. After including these factors, the health care provider typically receives less than the amount available by Medicaid.