Pediatric Doctors That Accept Medicaid - Pediatric neurologist Katherine Mazzola talks to one of her patients, Kaylee Lancaster, whose parents have private insurance. The doctor did accept Medicaid patients, but she complained that it took her staff nine months to complete the paperwork to get her on the list.
New Jersey residents who are covered by Medicaid report that it can sometimes be difficult to find doctors, especially specialists, who will accept their insurance plan. Below are some tips received from physicians, physician practice administrators and other patients, along with some observations based on Advance Media's opinion on program access issues:
Pediatric Doctors That Accept Medicaid
* When you sign up for FamilyCare, choose a plan that includes a doctor you already use. If you don't choose a plan, the state will eventually assign you a plan that may or may not meet your needs. You have some time to switch, but it's better to choose the best plan from the beginning.
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* Don't waste time dialing names in the phone book. Instead, start with the list of providers provided by your managed care plan. If your local doctor accepts other Medicaid plans but not yours, keep looking.
* Try to contact a federal medical clinic. Almost every county has one, and although they don't usually have many specialists, they can handle the most common ailments. In addition, they are open in the evenings and on weekends.
* If your PCP recommends you see a specialist, ask the staff to suggest some possible names. They usually know who is accepting new patients and who is not.
* Be aware that Newark, Camden, and New Brunswick have medical schools and teaching hospitals, many of which have Medicaid doctors.
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*You can visit the New Jersey Department of Consumer Affairs website to view your doctor's records. There you can view the doctor's credentials as well as his court history.
*Be open to travel if possible. All five programs compete in the state's more populous counties, while only two or three programs compete in the smaller counties. For example, you may have more options if you enroll in a program near where you work.
* When you call your doctor to ask if he is part of your plan, don't just ask if he accepts Medicaid. Instead, use the specific name of your plan: for example, UnitedHealthcare Community Plan or Horizon Health.
*When choosing which plan to join, keep in mind that while larger plans have more doctors, they will also have more patients seeing the same doctors as you.
Primary Care Clinic
* When you find out the doctor accepts your plan, ask about the wait time for an appointment. Although doctors' offices are supposed to treat all patients equally, some have been known to control the number of Medicaid patients, increasing wait times for appointments.
* Three magic words: "One Case Agreement." If you can't find a specialist for your condition, call your insurance company and insist that they find you a doctor. If you're looking for a family doctor or pediatrician (who will oversee your health care on a long-term basis), then this strategy won't work. But it can be useful if you're looking for an expert on a single health issue. Some patients are very lucky with this, while others face a battle.
* change plan. You can do this for any reason during the first 90 days, and for "good reason" after that. That way, if your doctor drops your plan, or if you're generally not happy with the care you're getting, you can switch. To make changes, contact your state Medicaid health care coordinator at (800) 701-0710.
* This is also the number to lodge a complaint with the state government. They monitor the reliability of the insurance company's network. To be a squeaky wheel.
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This article is a project of the USC Annenberg School for Journalism's National Health Journalism Fellowship Program.
You can contact Kathleen O'Brien at [email protected] or (732) 902-4557. Follow her on Twitter @OBrienLedger. Find it on Facebook.
Medicaid finances approximately one-fifth of individual health care spending in the United States. Unfortunately, most low-income health care consumers may find it difficult to find a doctor who accepts Medicaid within a reasonable period of time. Variable and low reimbursement rates, combined with administrative requirements for public insurance, have caused most local general practitioners to avoid insurance. Here's how to find doctors who accept Medicaid.
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Medicaid is a structured federal-state partnership that meets federal standards. States administer Medicaid programs and have flexibility in determining what services are covered, models of care, and how doctors and hospitals are paid. The first step should be to visit your local state health department website. Physician Compare by CMS lets you search by clinic name, medical specialty, health condition, or organ system. You can access a list of doctors who accept Medicare. Most clinics also accept Medicaid, making this directory great for finding doctors who accept Medicaid.
You can also find state Medicaid provider directories that list doctors, hospitals, medical equipment, pharmacies, and professional services. Most directories allow you to enter your zip code to help you choose a doctor who accepts Medicaid in your area. You can also narrow your search by various ranking factors, such as provider language, specialty type, hospital affiliation, or gender. You can also find out about office hours, board certifications of participating physicians, and whether the office is accepting new patients.
States often contract with health insurers to connect with doctors, providers and patients to facilitate payment. You may need to find out which insurance company offers Medicaid benefits in your state. For example, New York State Medicaid managed care plans are offered through UnitedHealthcare Community Plans. Contacting these insurance companies can help you find a doctor in the Medicaid network in the Hudson Valley.
Another way to find a doctor who accepts Medicaid is to contact your doctor's office. You can contact your GP and ask if they accept insurance. Also find out if they are accepting new patients. You can get explanations and answers to any questions.
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You can ask your friends and family to recommend doctors they know who receive Medicaid. The card can be brought to the doctor's appointment. A quick online search for family clinics can help you find out if they accept Medicaid. Community health centers are another good option.
Medicaid plays a key role in providing affordable health care to low-income families across the country. Finding a doctor who accepts Medicaid can be quite difficult. If you are looking for a doctor in the Hudson Valley who is Medicaid eligible, contact Cornerstone Family Healthcare. Christina Bocacci Follow @CristinaBocacci, Crista Fields, Giselle Casillas and Liz Hamel on Twitter @lizhamel
Policymakers, researchers and the media regularly ask questions about how difficult it is for Medicare patients to find doctors they can see. Previous studies have shown that the vast majority of physicians accept Medicare, but a smaller proportion of new Medicare patients, particularly primary care physicians, compared to specialists. 1 Primary care is especially important for Medicare beneficiaries—the 55 million seniors and adults with permanent disabilities—because they are more likely than others to suffer from multiple chronic conditions.
This note is based on data from the 2015 Kaiser Family Foundation/Commonwealth Foundation National Survey of Primary Care Providers and provides results for non-pediatric primary care physicians who see Medicare patients. In addition to comparing physician acceptance of Medicare with private insurance and Medicaid, this note examines the characteristics of non-pediatric primary care physicians who accept new Medicare patients and account for the majority of Medicare patients on their caseloads. Given their Medicare focus, the analysis was limited to non-pediatric primary care physicians. The survey methodology is presented in the appendix.
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The vast majority of non-pediatric primary care physicians (93%) said they accepted Medicare, as did private insurance (94%) (Figure 1). Most primary care physicians also said they accept
Medicare patients (72%), but this was slightly lower than the proportion of primary care physicians accepting new patients with private insurance (80%).
Figure 1: More than 9 in 10 primary care physicians accept Medicare (similar to private insurance), but relatively low acceptance of new Medicare patients
Low percentage of non-pediatric primary insurance compared to Medicare and private insurance
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