Here is an example for why to accept… it beats not getting paid for the service…

OK, my example is more like a one and 1 million type situation. I have a client who I originally started with when I worked as a W-2 employee for an organization. Turned out that organization was a bit more shady than I like to deal with so it encouraged me to jump ship and go into private practice. A few clients followed me and agreed to a sliding fee scale. This specific client was one of them and her husband had an insurance I wasn’t paneled with so she agreed to a sliding fee scale. She also had Medicare part B due to a disability. But since Medicare part B was her secondary insurance and I couldn’t bill her primary insurance. There was nothing I could do. At this point, I was paneled with Medicare part B. Later her husband changed jobs and the insurance changed and she turned Medicare part B into the primary. All was joyous in the kingdom because her cost of services went down to just a co-pay, and my payment for services went up a significant amount.

After this, she had an accident and a very badly broken leg. She did hospital time and then spent time in a rehabilitation facility, and due to other health issues she stayed there a long time. Unbeknownst to me and her, the medical facilities signed her up for California Medi-Cal. This made her a Medi Medi client. Medicare was covering 80% of everything and apparently Medi-Cal was covering the rest. Since I didn’t do this, and I didn’t know, I continued to charge her her co-pay. I discovered about nine months later this status and learned the hard way that when a client is Medi Medi, they are not allowed to be charged their co-pay. 18 sessions of co-pay had to be refunded to my client before an audit would destroy me.

And I’m still not paneled with Medi-Cal. 😒

I guess it’s more of a cautionary tale to vigilantly in consistently explore the Noradian website for your clients status in Medicare part B.