Dumb question about Obamacare. Hope someone can answer.....

vlagrl29

Gdaisy09 said:

Thank you, at least my masters in health policy is useful for something

that was impressive!  there is a nurse in our neighborhood who recently told me why hospital costs are so much.  I guess medicaid doesn't pay out for lots of things so they have to raise the cost to offset it.

formerlyGDaisy09

vlagrl29 said:

Gdaisy09 said:

Thank you, at least my masters in health policy is useful for something

that was impressive!  there is a nurse in our neighborhood who recently told me why hospital costs are so much.  I guess medicaid doesn't pay out for lots of things so they have to raise the cost to offset it.

Medicaid will refuse to pay things (some insurance companies will also refuse to cover some things), CMS has specific ways things need to be coded in order to cover them, there was a story on NPR in the fall that discussed the use of "observational status" resulting in people being denied coverage for rehabilitation or assisted living care because they were never formally admitted to the hospital, I think 60 minutes covered it recently too. A lot of private practices refuse to accept Medicaid because it often reimburses for less than 50% of costs, medicare usually reimburses around 80%.

catsareniice1

Gdaisy09 said:

vlagrl29 said:

Gdaisy09 said:

Thank you, at least my masters in health policy is useful for something

that was impressive!  there is a nurse in our neighborhood who recently told me why hospital costs are so much.  I guess medicaid doesn't pay out for lots of things so they have to raise the cost to offset it.

Medicaid will refuse to pay things (some insurance companies will also refuse to cover some things), CMS has specific ways things need to be coded in order to cover them, there was a story on NPR in the fall that discussed the use of "observational status" resulting in people being denied coverage for rehabilitation or assisted living care because they were never formally admitted to the hospital, I think 60 minutes covered it recently too. A lot of private practices refuse to accept Medicaid because it often reimburses for less than 50% of costs, medicare usually reimburses around 80%.

Is that the case for Medicaid even if you get it through a the state and use say United Health or Neighborhood Health?

formerlyGDaisy09

I'm not an insurance expert, however, Medicaid is a state-run program...so I guess it depends on your state. Care providers have the option (with the exception of critical access hospitals) to not accept medicaid as a form of payment. I can't speak to United HEalth or Neighborhood Health specifically, but I imagine that practices would have a right to choose not to take those forms of payment too.