Patient: Getting Doctors to Accept Medicaid is Tough

Getting approved for Medicaid didn't help one Upstate woman enough. She says every doctor's office she called turned her away. Dianne Derby pushed her problem into the hands of the decision makers and found a way for you to get the health care you need.

By: Dianne Derby | WSPA-TV
Published: October 29, 2009

Georgeanna Thesing is barely making it in this tough economy. The only job she could find is part time and it doesn't include medical insurance. That's why she applied for Medicaid. It's the federal and state funded health insurance plan for needy people. Once she was approved she began calling doctors to get an appointment for a check up.

"I called about five doctors in a row and all five said no they are not accepting new adult patients," Thesing said.

She called Medicaid for help and they sent her a website link to a list of doctors.

"I called at least 25 that were on that list and they said no they are not accepting new Medicaid patients so that's when I decided to e-mail you," said Thesing.

S.C. Medicaid Information

For information on changing you S.C. Medicaid plan call:
1-877-552-4642

Who is eligible?

Medicaid Application and Forms

How and where to apply

Contact Info

Medicaid Guide

Income Limits

Medicaid Office Locations

Search for Medicaid providers

N.C. Medicaid Information

For information on your N.C. Medicaid plan call:
1-800-662-7030

Who is Eligible?

How and Where to Apply

Contact Info

Your Rights

Find a Doctor or Dentist

Income Limits

7 On Your Side sent her complaint directly to South Carolina Department of Health and Human Services spokesperson, Jeff Stensland

When we asked Stensland why Thesing couldn't get a doctor to accept her as a patient he replied, "We do maintain a list of all providers that are enrolled in the Medicaid program but just because they are an enrolled provider doesn't necessarily mean they are accepting new medicaid patients. That's really a decision they have to make."

7 On Your Side learned the Center for Studying Health System Change reported that from 2004-2005 one in five doctors wouldn't even take new Medicaid patients.

"That's really the issue and that's why access to care is such a critical issue particularly when we look at some of the healthcare reform proposals that they're talking about at a national level," said Stensland.

"There is a very good possibility we could have tens of thousands of new Medicaid eligible people in South Carolina and the question is will the provider community step up and absorb some of those newly eligible folks," Stensland said.

But Dr. Carolyn Fields says Medicaid doesn't make it easy on them.

"It would make it a lot easier to do that if the reimbursements were better," said Fields.

She said Medicaid typically will only pay half what she bills a patient. For the time her staff has to invest in processing the paperwork, taking on a Medicaid patient likely won't pay off.

"It's just increasingly difficult to cover expenses and unfortunately that's bad for Medicaid patients," said Fields.

Luckily for Thesing, she was able to find a doctor. Once we contacted SCDHHS they changed her plan. Now she has the chance to get the healthcare she needs and deserves.

"I just want to thank WSPA On Your Side very much because if it wasn't for you I think we would still be making phone calls," Thesing said.

Whether you are uninsured or are covered by Medicaid or Medicare you can find a doctor that will give you the primary care you need. The best way to get help is to contact the South Carolina Primary Health Care Association. They have a list of non-profit community health care centers. You can call them at 800-438-3895 and they can tell you where the closest center is to your home or click here for a link to their website.

Click Here for N.C. Social Services Locations

For information on changing you S.C. Medicaid plan call 1-877-552-4642

Health plan charts

for SC adults

Abbeville

Aiken

Allendale

Anderson

Bamberg

Barnwell

Beaufort

Berkeley

Calhoun

Charleston

Cherokee

Chester

Chesterfield

Clarendon

Colleton

Darlington

Dillon

Dorchester

Edgefield

Fairfield

Florence

Georgetown

Greenville

Greenwood

Hampton

Horry

Jasper

Kershaw

Lancaster

Laurens

Lee

Lexington

Marion

Marlboro

McCormick

Newberry

Oconee

Orangeburg

Pickens

Richland

Saluda

Spartanburg

Sumter

Union

Williamsburg

York