By Gary Iscoe
According to a New York Times article, Nicole R. Dardeau, 46, a nurse “could not work because of unbearable pain in her right arm. Doctors have found three herniated discs in her neck and recommended surgery, but cannot find a surgeon to take her as a Medicaid patient.”
This is all too often the problem with finding a medical specialist who will accept any insurance payment for providing much needed care. Accident victims face the exact same challenge—doctors don’t want to take Medicare or Medicaid if they don’t have to.
The Medicare Secondary Payer Laws: Per 42 U.S.C. 1395y (b) (2) and 1862 (b) (2) (A) (ii) of the Act, Medicare is precluded from paying for a beneficiary’s medical expenses when payment “has been made or can reasonably be expected to be made…under a Workers’ Compensation plan, an automobile or liability insurance policy or plan (including a self-insured plan) or under no- fault insurance.”
Accident victims have traumatic injuries and are in need of critical care, closer in time to their traumatic event. Many times, medical specialists such as neurologist, orthopedics, neurosurgeons, and the like are needed rapidly to respond to the sudden chronic injury from a traumatic event such as a car wreck or a fall down stairs.
The medical needs from trauma usually differ from those with chronic medical problems that develop over months, years, or a lifetime. The care and maintenance issues for these chronic issues, such as diabetes or blood pressure problems, are usually not as urgent as those who have suffered a debilitating car wreck, and are in agonizing suffering and pain.
The insurance industry and the Florida Legislature are trying to impose Medicare rates as the standard of reimbursement for innocent victims of negligence. Insurance company lawyers routinely attempt to present evidence in Court of Medicare and Medicaid reimbursement, as the standard by which medical expenses should be paid, and what should be paid for medical care that is reasonably certain to be incurred in the future.
These so called “medical billing experts” wish to present evidence of what Medicaid pays as a basis for what is a reasonable rate of reimbursement for a doctor’s service.
Unfortunately, I cannot ask a judge, jury, or insurance adjuster if they will agree to reimburse injury victims for the difference as to what it will actually cost to care versus the legislative fiat of imposing a flat rate. Perhaps that is why the vast majority of medical practitioners in the U.S. decline to accept Medicaid for services rendered to their patients.
Source: “Cuts Leave Patients with Medicaid Cards, but No Specialist to See.” Pear, Robert. NY Times. April 2 2011.