Care for Medicaid and Medicare Patients
As a specialist care practice, we wish to provide our expertise to those that will benefit from it, particularly when there are case specifics that truly demand complex care than may not be available elsewhere. As such, we reserve a portion of our time to care for the patients who might not otherwise be able to access our services.
In service to our community and this goal, we contract with the CareOregon medicaid plan, and reserve an amount of time each month for caring for CareOregon patients who could benefit from our care.
At this time we are not accepting medicaid cases for diagnostic laparoscopies for endometriosis. Because of our limited availability for medicaid cases, we spend this time for cases that clearly require advanced care (ie bowel, thoracic endometriosis, etc). If no laparoscopy is done to demonstrate this need, or it is otherwise demonstrated by convincing imaging, another gynecologist will need to have done a laparoscopy to demonstrate this level of disease before we will consider the case. All medicaid cases must be reviewed by an NWEPS physician prior to acceptance into the practice. We realize these rules limit access to our care, but we also must protect what limited time we are able to devote to medicaid cases for those cases that most require our skill set.
At this time, we are unable to independently care for patients with other Medicaid plans, as even if we discount our fees to an adequate level, Medicaid / OHP will not pay for facility fees associated with care if care is not provided by a Medicaid / OHP contracted physician.
If you have a Medicaid plan that is not CareOregon, we cannot see you without a referral that has been approved by your insurer. This must be obtained through your work and through your referring physician, as we do not have the resources to do this for you. This requires not only that the referral that has been made by your referring physician, but also that this referral has been approved and transmitted to our office. Unfortunately, this process can be time intensive and in many cases not successful, and as such we do not have the staff resources to get this referral for you.
If you have an out of state medicaid plan, it is very unlikely you will be able to get a referral to see us under your health coverage. Each medicaid plan is state funded, and out of state referrals are rare.
It is also an issue that CareOregon, as well as other medicaid plans, are resource constrained and are not always willing to approve requests for surgery. While we can apply and in some cases appeal, if we can see you as a patient but cannot get approval from your carrier for surgery, we may be unable to do surgery for you.
We are not contracted with medicare. As such, all services provided to Medicare patients will be on a cash-only basis. In most cases, Medicare will pay for ancillary services such as hospital fees, anesthesia, and pathology. Due to federal law, we are unable to bill secondary commercial insurance for patients with Medicare primary coverage. In this situation, while in theory one would have coverage with the secondary carrier, because we cannot bill medicare we will be unable to successfully process a claim with the secondary carrier.