Law prevents Medicaid recipients from getting direct care

“It is actually illegal for this provider to take a private salary or direct payment from a Medicaid member,” a licensed professional counselor told Arvada.

DENVER — Getting an out-of-network medical bill could cost you thousands of dollars.

A Longmont mother wants to pay out-of-pocket and, essentially, out-of-network for the care of her daughter, who is on Medicaid.

“A couple told me [of doctors] that it was, in fact, insurance fraud to try to make an appointment with someone who didn’t take Medicaid,” mother Mary Keiran said. “Quite frankly, I was horrified to learn that we couldn’t pay ourselves.

Medicaid is for low-income people, but also for people with certain disabilities like Keiran’s adult daughter.

She was looking for a dermatologist for her daughter when she discovered that she was asking the doctor to commit a crime.

“You have to go to someone on Medicaid. You can’t go to someone else. I don’t understand,” Keiran said. “If you can’t find a particular provider for something, a service that you need or want, why can’t you pay for that service yourself?”

“It is actually illegal for this provider to take a private salary or direct payment from a Medicaid member,” said Sybil Cummin, licensed professional counselor at Arvada.

“A 50-minute counseling session covered by Medicaid, it is illegal for a provider who does not accept Medicaid to accept private payment from that client,” Cummin said.

“It was put in place to prevent Medicaid members from being exploited by certain providers to collect direct payments,” said Marc Williams, spokesman for the Colorado Department of Public Health Care and Funding.

Williams said the law dates back to a bill passed by the state legislature in 2006.

“It’s understandable that it doesn’t make sense to people,” Williams said. “Frankly, our preference would be for providers to enroll in Medicaid.”

Medicaid providers have had repeated problems over the past few months.

RELATED: Why Some Medicaid Providers in Colorado Are Not Being Paid

Late last year, 199 Medicaid providers were billed to reimburse one of the state’s Medicaid networks for services the providers say they provided. After reporting by 9NEWS and The Colorado Sun, the refund bills disappeared.

Earlier this year, Medicaid providers said they were not being paid for services.

Providers considered leaving Medicaid because of these issues.

“Medicaid members might be looking for a therapist and they might be put on a waiting list for six months. And then during those six months their mental health will decline or they’ll just give up and they won’t look for it. not the services they need,” Cummin said. “There’s a pretty big disparity between what therapists get paid out of pocket and what they get paid by Medicaid.”

“It’s very, very difficult to find providers within the Medicaid network,” Keiran said. “In the services my daughter has received, Medicaid has been amazing.”

Keiran would like the system to work like private insurance, where you can choose to go to an out-of-network provider and pay.

“I don’t know how to make a change, but if we don’t talk about it, it will never start,” Keiran said.

RELATED: Providers say surprise bills from Colorado Medicaid Group could impact patient care

> Watch live 9NEWS programs, original shows, daily forecasts and top stories on your Roku or Fire TV via the free 9NEWS app.

SUGGESTED VIDEOS: Full Episodes of Next with Kyle Clark

Subscribe to our 9NEWSLETTER daily for top 9NEWS stories curated daily just for you. Get content and information now for can’t-miss stories, Next and Broncos content, weather and more straight to your inbox.

Google Play:


ROKU: add channel from ROKU store or by searching KUSA.

For Apple TV and Fire TV, search “9NEWS” to find the free app to add to your account. Another option for Fire TV is to have the app delivered straight to your Fire TV through Amazon.

Comments are closed.