Reimbursement of Medical Care for Immigrants

[The Straight Story]

Reimbursement of Medical Care for Immigrants
Physicians face challenges in getting reimbursed for the care they provide to immigrants.

Laura D. Hermer, JD, LLM

Physicians who serve large immigrant populations know that it can often be difficult to collect reimbursement for care of patients who are not citizens, due to their economic status, lack of private insurance, or ineligibility for public health coverage. Immigrants generally use substantially fewer health services than the native-born population, but, of course, still need medical care <1>. How can a physician get paid for providing services to this often poor and uninsured population?

With respect to the first point, fully 45 percent of unnaturalized U.S. residents are uninsured <2>. This problem is multifactorial. Immigrants to the United States tend to be either highly educated (often science PhDs) or poorly educated <3>. Those in the first group are often better paid and more likely to be insured than the native-born population <3>, but they are far outnumbered by immigrants who fall into the latter group <3>. While less-educated immigrants are as likely or more likely than native-born Americans to work, they disproportionately work in low-paying jobs in the service sector that usually don't provide health benefits <4>. Accordingly, foreign-born workers, taken as a whole, are significantly less likely to have employer-sponsored private health insurance <5, 6>. And because they also have lower incomes, they're less able to pay for care out-of-pocket.

...........

Obtaining public funds for physician services to immigrants who do not otherwise qualify for assistance is more difficult. To obtain reimbursement for services rendered through 2008, physicians must apply through section 1011 of the Medicare Modernization Act, under which the physician must first establish that no third-party funding other than Emergency Medicaid exists for the specific care in question or that, if it does, the physician has extracted all possible reimbursement from those third parties prior to seeking section 1011 funding <17>. If a balance remains, then Medicare providers must first submit a form CMS-10115 to Trailblazer Health Enterprises, L.L.C., which administers the program for the federal government, within 30 days of the close of the federal fiscal quarter following the quarter for which the reimbursement is being sought <18>. Physicians who are not already Medicare providers must either enroll or file an additional form <18> and then submit Form CMS 10130A 05/05 with supporting documentation to TrailBlazer <19>.

The supporting information and documentation are not easy to obtain. Physicians must first determine whether the patient is eligible for or enrolled in Medicaid or Emergency Medicaid <20>. For those patients who are not, physicians must state the reason for the lack of enrollment <20>. They must then determine whether the patient is a foreign national with one of two types of entrance documents <20>. If not, then they must establish that the patient was born in a foreign country and provide one of several forms of supporting documentation <20>.

....

In sum, obtaining reimbursement for care provided to many immigrants who lack private health insurance and cannot afford to pay for their care out-of-pocket can be difficult, and, except in emergency situations, often may not be possible under present law.

http://virtualmentor.ama-assn.org/2008/04/pfor1-0804.html

[Kali]

1. You know, when I read articles and language like this:

"Physicians who serve large immigrant populations know that it can often be difficult to collect reimbursement for care of patients who are not citizens, due to their economic status, lack of private insurance, or ineligibility for public health coverage. Immigrants generally use substantially fewer health services than the native-born population, but, of course, still need medical care <1>. How can a physician get paid for providing services to this often poor and uninsured population?"

and then think of my own situation, I suspect it is being used in a racist and xenophobic way to instill anger and fear in the reader.

If we would allow our perspective to be one of viewing other people as just other human beings rather than some color, or economic or immigration status we might move beyond a lot of problems that are really pretty imaginary and based on prejudice.

[The Straight Story]

2. True, but

It is a real issue in the medical field - it is easier to get reimbursement for a citizen than a non-citizen. I work in the ambulance field and the trailblazer program came up in a meeting yesterday (talking about software, etc). We service a lot of migrant workers and we don't get paid for runs if we don't have all our paper work in order.

[TCJ70]

3. Quick question:

What are the criteria for being an "Unnaturalized U.S. Resident"?

Is that another term for illegal immigrant? I really don't know.

[Lance_Boyle]

4. wouldn't that cover green card holders?

they are not naturalized citizens (or citizens at all), but they are legal (not illegal) aliens.

[TCJ70]

5. Just talked to a friend of mine who's here from New Zealand

They have a green card but aren't a citizen, just a resident. Apparently there's some time restriction on citizenship. I guess that answers my question. If anyone else has any other information it'd be handy though.

[OhioChick]

6. This is a real issue for physicians

and i don't believe it has anything to do with race. While taking my Grandmother to certain Physician offices there are often signs posted "Medicare not accepted here."

I do truly believe that many physicians get into the field to help/save lives, but they cannot all be pro-bono cases. They have families and student loans to pay off, as well.