My First Post

[DianaCox]

@Larra - Not Medicare, NV Medicaid.

 

[Larra]

Yes, I know he has Medicaid, but don't some people have both Medicaid and Medicare? Even if not, no harm in asking.

 

[DianaCox]

The problem is Medicare is federal while Medicaid is state-based. Which is why going out of network is more problematic for Medicaid, and surgeons contract, if at all, only with their own state Medicaid program. That's why he needs to figure out FIRST how much NV Medicaid would pay to an out-of-state surgeon. I don't think even if Dr.K or Dr.R took Medi-Cal, that it would make any difference with respect to whether the would accept his NV Medicaid insurance as payment in full, because they are not and cannot be contracted with NV Medicaid. But I ALSO don't know whether NV Medicaid can refuse to pay for a competent surgeon, no matter where located, to perform a medically necessary surgery on him.