[Tobra]

Short answer, because they can get away with it.

There are number of reasons though.

Podiatrists are excluded from Medi-Cal as providers, but the services I provide are covered if done by an MD. I still think the state association should have filed a class action suit for that 5 years ago, when these shenanigans were first pulled, but that is neither here nor there. This does not release me from my responsibility to see those patients if they turn up in the ER and I am on call.

Another way this happens is if Medi-Cal is a secondary insurance. For example, it used to be that if someone had medicare and medi-cal as a secondary insurance, medicare would pay 80% of allowed charges and medi-cal would pick up the remaining 20% of the discounted fee. They would still pay me in that situation, I believe because it would violate federal law if they did not, but I am not sure why they would pay if secondary. They have done a few things in the last few years that have resulted in that 20% never getting paid. Generally the reason given for this was that the 80% that I got from Medicare was more than they allowed, so we are not paying our end. I believe this has something to do with them lowering their fee schedule so it is the lowest reimbursement for any Medicaid program in the country.

This usually is not more than a hundred dollars per patient, depending on the service provided, but it adds up. You do a couple a week, and it turns into a grand by the end of the month. I don't mind doing free stuff for individuals, but doing free stuff for the state is too much.