If someone’s carelessness caused you to get medical treatment, and you are a Florida Medicaid beneficiary, then a Florida hospital or doctor is not required to bill Medicaid.
Medicaid is a payer of last resort for medically necessary goods and services furnished to Medicaid recipients.1 This means that if there is another source of payment for your medical bills, then the hospital or doctor can elect to bill that party. Although Medicaid is a payer of last resort, Medicaid will generally pay accident related bills.
Typical sources of payment for your medical bills in a car or truck accident case may be first party coverage (e.g. including, but not limited to, PIP, Medicare, workers compensation, etc.) or other parties against whom you can make a tort claim.
In a slip or trip and fall case, other sources of payment include first party coverage and/or the owner, operator, property manager, landscaper or cleaning company of the business establishment or other place where you fell. There are other sources of recovery in a slip and fall case, and other non-motor vehicle accident cases, but I won’t get into those here.
The reality is that a hospital or doctor is much more likely to refuse to bill Medicaid if you are involved in a motor vehicle accident – as opposed to a slip and fall – because the provider may be entitled to PIP payments. PIP pays the medical providers at a higher rate than Medicaid. Thus, thus the medical providers prefer that they receive PIP payments instead of Medicaid payments.
If a provider bills and accepts Medicaid payment, then the provider cannot balance bill you. This means that you will likely not owe a balance if the provider accepts a payment from Medicaid. This may result in a smaller full settlement value of the case than if you did not have health insurance or, in most instances, if you had health insurance. A smaller full value of the case generally results in a smaller settlement value.
University of Miami Medical Group (UMMG), who in the past has supplied emergency room doctors at Jackson Memorial Hospital (JMH) has billed Medicaid in car and motorcycle accident cases even though a third party’s negligence caused the patient’s injury, and PIP was not available.
I heard on one occasion that Holy Cross Hospital (Fort Lauderdale, Florida) refused to bill Medicaid when a third party was possibly liable.
If someone’s carelessness caused your injury, you should quickly apply for Medicaid if you think you qualify. You will have to repay, at least to some extent, Florida Medicaid from your personal injury settlement if Medicaid pays some of your accident related medical bills.
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