California cash pay private practice - how to deal with patients who have medi-cal (medicaid)?

[SChip MediCal]

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I work at a large clinic that accepts managed medi-cal (medicaid in California) as my main job. But now I'm starting a small solo cash pay private practice on the side with a different niche.

Am I allowed to charge cash to patients who have medi-cal or managed medi-cal so long as a claim is not submitted to medi-cal? Some patients w/ medi-cal have their more wealthy family members paying cash on their behalf. I've heard that as long as the services I offer are not covered by medi-cal, I can charge them cash, but I'm not sure if this is true. Having a hard time finding a clear answer to this question. Do I need to have the medi-cal patients sign a separate payment agreement to indicate that my services are not covered by Medi-Cal?

I can structure things to avoid charging medicare patients (by focusing on certain age groups) but its much harder to screen out medi-cal patients especially because there are many managed care plans and people have primary and secondary insurances, or may switch insurances mid way through care with me. It is something that can easily slip through.

 

[splik]

You can charge medi-cal patients cash if you aren’t a medi-cal provider with their plan but it sounds like you are. It’s a dicey area and the California medical association recommends against seeing medi-cal patients privately but many people (including myself) do. But it’s a different story if you are a medi-cal provider.

And what you are saying about non-covered services is a separate thing, but almost anything you might reasonably offer would be a covered service unless you’re doing reiki or something.

 

[Sushirolls]

Medicaid for most states is like private insurance, in the sense that it is linked to a practice address and even a type II NPI.

So you are enrolled/ in network with your main job. But your new employer, you, at your new cash practice is not. That practice address is not in network, and most states medicaid works in manner that you are fine to do what you want.

Medicare is the one where you can't....

 

[randomdoc1]

watch out for those on ssdi as well. many are on either straight medicare or medicare through an HMO. So you don't need to be over 65 basically. A lot of patients have so little understanding of what they carry for insurance and yes, a good half or more will not even let people know when they have a change. In my practice, I just search through databases start of every month all patients scheduled for the month. And it's a very regular occurrence...I never rely on patient report.

I also managed to set up some software to do 80% of the bulk running so very little is done by hand on my end ; ). Love using tech in practice.

 

[comp1]

Goodness this sounds like a mess and an absolute ethical (probably also legal) trap. If you want more money and to keep your day job, pick up some call or weekend shifts at your local inpatient unit.