Dual Eligible Molina Patients: An Ethical Dilemma

We need your assistance in resolving an on-going problem. We are having difficulty getting paid for services that we have provided to five Dual Eligible Molina patients. Molina has authorized and continues to authorize services for these patients, however when we bill for services rendered, Molina is denying the claims as benefits have been exhausted. We then would expect SC Traditional Medicaid to pay for these services as the patients do have continuous care benefits. We are unable to bill directly to SC Medicaid because your plan still has these patient enrolled as Managed Care members.

As of today we have $$$$ in outstanding payments with no clear path to resolving the issue. This issue has caused tension in our organization and