with the exception of what medicaid would/would not cover (which i don't see as any different than private insurance which has exclusions on coverage as well) the program didn't/doesn't today dictate what doctor can be seen-that bus is driven by the doctor/providers who choose if they will accept medicaid patients or not.
i don't know what the ideal solution is. my ppo is a pain to deal with and i believe purposely bounces the bulk of the claims hoping clients get fed up with the time consuming appeals process and end up paying out of pocket for valid covered services with valid contracted providers. it's insane trying to deal with facilities that are 'in network' only to find that whichever provider you were billed under either isn't or only is at a different location of the identical facility (something i'm dealing with right now). my state has recognized the issue with consumers being mistreated in regards to private insurance billing and coverage practices and the following explains what they are doing to address it (a step in the right direction to my way of thinking cuz i'm sick of being stuck in the middle of a p...... fight between my providers and the insurance company they contract with)-
Commissioner Mike Kreidler has proposed legislation that would prevent people from getting a surprise medical bill when they seek medical services from an in-network facility, but are treated by an out-of-network provider. If an insurer and provider cannot agree on a price for the covered services, they can go to binding arbitration but cannot bill the consumer for the amount in dispute.
His bill passed the House of Representatives on March 4 with a strong bipartisan vote of 84-13, passed the Senate on April 10 with a vote of 47-2. and was concurred on April 18 by the House on a 95-0 vote. Next, it travels to the governor's desk for his signature.
What is "surprise medical billing"?
Surprise billing occurs when you're treated for an emergency or scheduled procedure at an in-network hospital or surgery facility and are seen by an out-of-network provider. In addition to your expected out-of-pocket costs, you also get a bill for the difference between what your insurer has agreed to pay that provider and what they believe the service was worth.
Some types of providers, including anesthesiologists, radiologists, pathologists, and labs may not be contracted with your insurer even though they provide services at an in-network hospital or facility. This practice is also called “balance billing,” however, some balance billing is not a surprise. For example, if you're treated by a provider that you know is not in your plan's network, you shouldn't be surprised to receive a bill for their services, on top of what your plan covers.
