Medicaid coverage amount?

January 24, 2007 12:27 PM

How can I find out how much the standard Medicaid coverage is for a certain surgical procedure?

I was having dinner the other night with some friends, complaining about how expensive my recent outpatient surgery was, and a guy at the next table said he worked in medical insurance.

His advice was to offer the hospital the standard Medicaid coverage amount for the procedure - undoubtedly less than they initially charged - and that 9 times out of 10 they'll be happy with that amount.

But I'm having a tough time finding out how much that amount is. (I've already paid the surgeon and the anesthesiologist.)

posted by gottabefunky to health & fitness (10 comments total)

In which state are you?
posted by apocry_phil at 1:28 PM on January 24, 2007

New Mexico
posted by gottabefunky at 1:44 PM on January 24, 2007

Do you have the bill from the hospital with the procedure codes? Take this and then go to your state government web site and find their Medicare documents. Hopefully you will find some documentation which lists the maximum fee allowance for individual procedure codes. It might be called a Hospital Services Manual.
posted by caddis at 1:49 PM on January 24, 2007

Here, look under Fee Schedules
posted by caddis at 1:53 PM on January 24, 2007

Fee Schedules New Mexico Human Services Department

Like caddis wrote, procedure codes would be helpful. Ask for an itemized bill if you don't already have one.

On preview, caddis has it.
posted by badger_flammable at 1:57 PM on January 24, 2007

Thanks. (Am I confusing Medicaid with Medicare?)
posted by gottabefunky at 1:58 PM on January 24, 2007

Hmm...I do have an itemized bill, and every line has a six-digit charge code ("213608").

On the Fee Schedules, everything seems to have a four-digit code with an alpha prefix ("A4351")...?
posted by gottabefunky at 2:04 PM on January 24, 2007

Look at the cpt codes.
posted by caddis at 2:21 PM on January 24, 2007

sorry, those are five digits. I am out of my element here, this is getting quite specific. Perhaps someone who codes bills can chime in.
posted by caddis at 2:32 PM on January 24, 2007

Yes, it is Medicare, not Medicaid.
posted by rasputin400 at 6:58 AM on January 25, 2007