If you are eligible for Medicaid in the state of Pennsylvania, you will likely be able to get coverage to see a neurologist if it is medically necessary.
Below we’ll discuss Pennsylvania’s Medicaid system, requirements for Medicaid to cover treatment by a neurologist, as well as some of the best neurologists in the state, including those who accept Medicaid.
What is Medicaid?
Medicaid is a health insurance program for low-income for low-income families, pregnant women, the elderly, and the disabled. It helps provide very low-cost care so they can obtain the medical treatment they need.
While Medicaid is a federal program, it is administered individually by each state, so there are different rules regarding how to qualify for Medicaid or what it will cover depending on where you live.
Medicaid in Pennsylvania
In Pennsylvania, Medicaid is also known as “Medical Assistance” (MA). To apply online, you can visit the COMPASS online application portal.
If you receive Medicaid, your general practitioner will need to refer you to a specialist such as a neurologist. Some specialized care also requires prior authorization before your appointment so that Medicaid can decide if it’s medically necessary.
The treatment you receive from a neurologist as a Medicaid beneficiary must be unique. They cannot duplicate services performed for you by another provider. If they are called in for a second opinion, you will still need permission to use Medicaid to pay for the visit.
Authorization to see a neurologist is negotiated between your doctor and Medicaid, and you can expect to hear whether or not you have received permission to visit a neurologist within 14 days, unless it is an emergency. In that case, it’s more than likely to be medically necessary.
You will also need to choose a neurologist who is willing to see new patients and who accepts Medicaid in Pennsylvania – not all of them do.
If you are denied access to a neurologist and you and your doctor feel it is medically necessary, you can appeal Medicaid’s decision. However, this does take time and will require your doctor to resubmit medical forms attesting to the importance of such care and the fact that they are unable to provide it.
Medicaid co-pays
If you are referred to a neurologist, you may be responsible for a copay. This is a small amount of money patients pay at the time of their service. These fees (usually a couple of dollars) help cover the cost of running the state’s Medicaid program.
You will want to check with your neurologist in advance to ask about their copay and find out what services will be covered during your visit. If more permission is required before performing a test, you may have to come back for another visit. Typically, each visit to a physician requires a copay.
What does a neurologist do?
Neurologists are specialist health practitioners who treat diseases related to the brain, spinal cord, as well as their peripheral nerves and muscles. Neurological conditions include things like multiple sclerosis (MS), Parkinson’s disease, epilepsy, concussions, and stroke.
In order to treat you, a neurologist will first take a detailed medical history from you and perform a physical examination. The latter may include testing your vision, speech, strength, response to sensation, coordination, and reflexes.
If more neurologic tests are necessary, your neurologist will likely have to get extra permission to perform them. These include things like: computed tomography (CT) or computer-assisted tomography (CAT) scans, magnetic resonance imaging (MRI), electroencephalography (EEG), or a lumbar puncture (LP). But tests are generally covered if your situation is an emergency.
When should you see a neurologist?
While a visit to a neurologist might not always be covered by Medicare, your doctor will often refer you if you have the following symptoms:
– Chronic, severe headaches
– Bouts of dizziness
– Persistent pain, weakness, tingling, or numbness in extremities
– Vision problems
– Seizures
– Tremors or shaking
– Severe or sudden memory loss
– Persistent sleep problem
– Loss of muscle strength
– Lack of coordination
– Impaired mental abilities
– Loss of feeling
While these aren’t always signs of a neurological problem, your doctor can help you decide if they warrant special testing to make sure they aren’t indicative of a more serious medical problem.
While neurologists treat brain disorders, they do not offer mental health treatment. However, it is important for you to share any symptoms of mental health issues with them.
If your neurologist cannot treat your symptoms or diagnose the problem, you may be referred to another type of specialist. These include:
– A speech therapist
– A physical therapist
– An occupational therapist
– A pain medicine specialist
– A physical medicine and rehabilitation physician
– A psychiatrist or other mental health professional
The top 10 neurologists in Pennsylvania
These neurologists consistently receive high marks from patients and/or are leaders in their field. Because insurance requirements change, you will need to check to see if they accept Pennsylvania’s Medicare coverage.
1. Dr. Sharon Lewis
330 S 9th St
Philadelphia, PA 19107
(215) 829-6500
2. Dr. Joseph R. Berger
Perelman Center for Advanced Medicine
3400 Civic Center Boulevard, 2 South
Philadelphia, Pennsylvania 19104
800-789-7366
3. Dr. Shawn J. Bird
Perelman Center for Advanced Medicine
3400 Civic Center Boulevard, 2 South
Philadelphia, Pennsylvania 19104
800-789-7366
4. Dr. Pasquale Brancazio
402 McFarlan Road
Kennett Square, Pennsylvania 19348
800-789-7366
5. Dr. Richard A. Buckler
920 Lawn Avenue, Suite 5
Sellersville, Pennsylvania 18960
215-257-4900
Neurologists who accept Medicaid
In addition to being talented neurologists, these doctors reported that they accept Medicare. However, you will need to double check and secure a referral from your primary care doctor before making your appointment.
6. Dr. Scott E Kasner
3400 Spruce St 2 Ravdin Building
Philadelphia, Pennsylvania 19104
(215) 662-3606
7. Dr. Mahesh D Chhabria
3 Parkinsons Road
East Stroudsburg, Pennsylvania 18301
(272) 212-0553
8. Dr. Ralf W Vander Sluis
802 Jefferson Ave
Scranton, Pennsylvania 18510
(570) 348-1118
9. Dr. Venkatachalam Mangeshkumar
640 E Oregon Rd
Lititz, Pennsylvania 17543
(717) 569-8187
10. Dr. Debra Byler
500 University Dr Hershey, Pennsylvania 17033
(800) 243-1455