can surgeon refuse choledocho-duodenostomy for medicaid coverage?

Question

My friend,85 years old man in good health condition, has recurrent stones in bile duct.The first time ,he was suffered from sepsis due to cholangitis with stone .4 months later,his gall bladder was removed .One more year later,he was perfomed stone removement by ERCP,This time,2 more years later,he is found to have bile duct stone,and diveticulums in his bile duct around sphyincter area.What kind of treatment is best ? Can a surgeon refuse choledocho-duodenostomy for medicaid coverage? Is there any way to get proper treatment? can his friends pay surgeon enough fee for compesation?

Answer 1

A physician is not required to provide service to a patient if they don't want to. Medicaid reimbursements are very low, and I know a number of physicians who do not accept Medicaid.

If the surgeon does generally accept Medicaid, then he is not permitted to accept extra money to perform the surgery. Insurance, Medicare, and Medicaid contracts specifiy exactly what the doctor will be paid for covered services - physicians are not permitted to charge more or less. If the doctor is not a medicaid provider, than you do have the right to pay him out of pocket for the surgery because he has not signed a Medicaid contract.

Answer 2

Any surgeon who refuses Medicaid is crazy. It pays maybe 15-20% less than commercial insurance. However, your friend should be eligible for both Medicare and Medicaid if financially qualified as a secondary insurance. I recommend looking for another surgeon who will take the case. Be mindful though that this may be deeper than the obvious. Surgeons do have the right to defer on a case due to the overall health condition of the patient. Some who do not have resulted in poor outcomes. Get a second opinion on both insurance and patent's appropriateness for surgery.

Answer 3

I've never heard of a surgeon refusing medicaid insurance, but I have heard of them refusing to take patients whose only means of paying was through medicaid.