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Hospital charges Medicaid, Medicaid approves, but no refund for us

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Confused001

Junior Member
What is the name of your state (only U.S. law)? Florida

I am not sure if I am posting in the right place, but I hope so.
I have a very long story which I will save you from hearing. Instead I will
cut to the chase as best I can.

My wife was admitted at a hospital for "pain management" for a
condition she needed surgery for. On the second day she was in, the surgeon she had been seeing called me back. He initiated a transfer for my wife to the hospital he works out of. We waited 4 days for a transfer with no word. I called them repeatedly and every time I was told everythings good and in "proper channels". Then on Friday night at 6PM. I received a call from the surgeon's hospital saying she wasn't eligible for any sort of assistance and being uninsured they needed a deposit to hold a "Theater" for her surgery on the coming Monday. They wanted a very large sum of money and kept telling me they knew my wife had opened lines of credit. I attempted to negotiate, but was met with, "I cant book a theatre for that". So, we charged this insane amount to our credit and finished it off with our bank funds. The next day, my wife was finally transferred, however her surgery did not occur until that Thursday due to the Surgeon not even being in town till Tuesday. When we arrived at the hospital, our surgeon's staff had no idea we were having surgery on Monday. They were very confused as to why the hospital asked for money since admissions wouldn't of had any idea of her condition. Also her Surgeon hadn't even seen her yet since he wasn't in town.

The next day, the hospital reached out and wanted to "help get our money back". Sent me running around to get different documents. They said they were going to file under Emergency Medicaid and wanted me to draft a letter stating my wife's condition and how it has impeded the last 2 years of our life. I did all that, and they said once it was approved, we'd get our money back..

Well we got approved, but no money. They don't return calls anymore and if by some chance you get one to actually pick up, they simply say they haven't been paid.

Friends and family keep saying I need to seek Legal advice, but I am a bit unsure.

Midnight curiosity and google led me here.

Assuming you are still with me and haven't hit the back button, I appreciate you reading my
story and any advice you may share.


THANK YOU
 


lealea1005

Senior Member
Well we got approved, but no money. They don't return calls anymore and if by some chance you get one to actually pick up, they simply say they haven't been paid.
There usually is some lag time between Medicaid's the notice of approval of services and actual payment.

When did you receive the written notice of approval?
 

barry1817

Senior Member
medical

government run health care. Ain't life just grand.

think it will get any better when they control all aspects.

Sorry for your problem, sorry for the above rant, but just stating the obvious for others, that government, as Reagan had stated isn't the solution but the problem.
 

CSO286

Senior Member
And if you paid your bill--or parts of it--with credit cards prior to medicaid kicking in, then you just might be out of luck....


ETA: Just spoke a supervisor in medicaid administration:

AS it was explained to me: If the healthcare provider required the patient to pay $xxxx.xx. toward their care while the medicaid application was pending, then once the application was approved, the healthcare provider could bill medicaid for the full amt of the bill as long as the provider reimburses the patient the amount they paid.
Now if the provider only bills medicaid for the differnce between what the patient paid and what the procedure cost, then the patient is out of luck.
The provider gets to decide which option to exercise. There is no law stating they must do A or B.
 
Last edited:

ecmst12

Senior Member
If the medicaid goes into effect on or before the date of service, then legally the hospital CAN NOT keep your money after they get paid by medicaid. They are not allowed to accept money from patients on medicaid, they have to accept what they are paid by the plan only. The whole point is if you qualify for medicaid, you can't afford to pay anything, and it would be taking advantage of the patients to take money from them.
 

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