Header for pages 2 and after of LAW Publication

Medicaid : Legal Action of Wisconsin


	YOUR RIGHT TO RECEIVE MEDICAID TYPES OF MEDICAID INCOME & ASSET LIMITS INCOME & ASSETS APPLYING FOR MEDICAID MEDICAID & W-2 MEDICAID DEDUCTIBLE MEDICAID EXTENSIONS GETTING MEDICAL SERVICES MEDICAID HMOs MEDICAID SERVICES MEDICAID PAYMENT PROBLEMS RULES FOR SPECIAL GROUPS FAIR HEARINGS TELEPHONE NUMBERS HMOs IN MILWAUKEE PUBLICATIONS HOME PAGE
MEDICAID PAYMENT PROBLEMS Can my doctor bill me if I am on Medicaid? In most cases your doctor cannot bill you if you are on Medicaid. After you tell your health care providers (doctors, hospitals, clinics, pharmacists) that you have Medicaid, they must bill the state for your services. If they do not do so within the time limits set by state law, they will not be paid. However, the law says that they cannot bill you, sue you or report you to the Credit Bureau. There are some exceptions: If a provider tells you she will not accept Medicaid and you agree to receive the services, you will have to pay the bill. If you are informed that a service is not covered by Medicaid and you agree in writing to have the service, you will have to pay for it. If you are in an HMO you must ask your primary doctor for a referral before going to a specialist. If you don’t, you may have to pay the bill. You may have to pay a small co-payment for some services. You can call the Managed Care Ombuds Program at 800-760-0001 if you get billed by a provider. If you get billed or sued by a hospital or other provider you can also contact Legal Action of Wisconsin at 414-278-7722. Will I have to pay for Medicaid services? At this time, HMO recipients do not have to pay for services provided by the HMO. Other Medicaid recipients may have to make co-payments of not more than $3 for some services. What if I have unpaid medical bills when I apply for Medicaid? Your Medicaid can be backdated up to three months from the day you apply, if you were eligible during those three months. You may be eligible during the three months before your application date, even if you are found ineligible at the time you apply. You must ask your caseworker to backdate your Medicaid. Once you get a Medicaid card you must give it to your health care providers (hospitals, clinics, doctors, pharmacists) and ask them to bill the state. If you have already paid them, the providers must pay you back once they get paid by the state. However, they need only pay you what they are paid by the state. Note: your providers have a certain time by which they have to bill the state. If they do not do so, they cannot hold you responsible for the bill as long as you have notified them that you are eligible for Medicaid. If a Medicaid card was never mailed to you, the time limit for billing does not apply. If I am working and have Medicaid do I have to take my employer’s health insurance? No, you do not have to take the employer’s health insurance. If you do, you will have to pay the premium but Medicaid will pay any co-payments and deductibles as well as services not covered by your insurance. Note: For BadgerCare, you may have to take health insurance offered by your employer. See TYPES OF MEDICAID.