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Non Contracted Managed Care Issue

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  • Melinda
    Posting on behalf of another office-general surgery in Washington State. I m getting more and more confused over DSHS/Molina(Managed Care)/CHPW (Basic Health
    Message 1 of 1 , Apr 13, 2010
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      Posting on behalf of another office-general surgery in Washington State.

      "I'm getting more and more confused over DSHS/Molina(Managed Care)/CHPW
      (Basic Health Plan-Managed Care).

      We are only contracted with DSHS on an emergency basis only. We are
      NOT contracted with Molina or CHPW. Molina keeps telling us we
      cannot balance bill pts as they are the same as DSHS as the card says
      Healthy Options so that is suppose to tell me we cannot balance bill
      pt. I do not believe this is true. Pts we see with these insurances are
      always from the hospital emergency and/or his on call committments.

      My question is whether this is true or not. I can't find anything that
      supports what the Molina rep told me. We do balance bill these pts but
      give them a huge discount - better than MDC. Molina won't pay for
      their surgeries - not a dime of it - only the consult so this forces us
      to balance bill the pt for the surgery.

      My question is can we balance bill pt after Molina and CHPW pay what
      little they pay even if we aren't contracted?"

      Melinda Brown, CMBS
      Ins Biller
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