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Medicaid Denials and
Doctor's Bills

When the money behind healthcare goes sideways, it's the patients who suffer.

This month, what you need to know about Medicaid denials. And, we talk about an increasingly common event that 'trickles down' to patient pockets.

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July HealthLetter
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4 Costly Medicaid Denials You Can Prevent
A Secret Reason Your Doctor's Bill Goes Up

4 Costly Medicaid Denials You Can Prevent

Denied.

It’s a word nobody likes to see. Ever.

But it’s even harder to see when it’s attached to needed healthcare coverage. And to add insult to injury, some denials don’t include an explanation of why we cannot have a drug or procedure that a doctor has said is necessary.

Recently, a group of District of Columbia patients won the right to sue the district for denying their Medicaid prescriptions without explanation. They argued that because they weren’t given a reason for denial, they couldn’t rectify the situation.

The result? The patients say they could not take necessary medications or were forced to pay for them out-of-pocket.

Medicaid is a critical program for those with a low income or a disability. Why does it deny some claims to create a barrier for needed health care or medications?

Here are four things you need to know about Medicaid denials:

 

1. The service may not be covered.

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A Secret Reason Your Doctor's Bill Goes Up

Doctors are human. And, like any other human being, they make mistakes.

But when it comes to medical care, the consequences of a blunder can be devastating. One way the U.S. healthcare system deals with doctor error is through malpractice suits, which allow patients to seek damages for a mistake that causes harm.

But what happens when a jury awards a high-dollar figure that runs into the tens of millions of dollars? As comforting as those verdicts might be to families affected by medical errors, they do have a huge impact on our healthcare system—and the people who use it every day.

 

Medical malpractice awards are rising.

Six states have had their highest medical liability judgments since 2010, but high-dollar malpractice judgments are a national problem.

The rate of awards over a million dollars jumped from less than 1% in 1985 to nearly 10% in 2010, according to the Physician Insurers Association of America.

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