If you have Medicaid, a doctor or hospital who accepts Medicaid is prohibited from balance billing you for services that Medicaid covers. This means that the provider cannot charge you more than what Medicaid paid, unless you make a private written agreement to pay more or you were told that Medicaid does not cover the service you need and you agreed to pay out of pocket for it. If you are being balanced bill by a Medicaid provider, please contact CHA at 888-614-5400 for help.
If you have Medicare and are a Qualified Medicare Beneficiary (QMB) you are protected by federal law from balance billing by a Medicare-enrolled provider for amounts above what Medicare paid. This means you cannot be billed for any cost-sharing including co-payments or co-insurance, for services covered by Medicare. If you are being balanced billed by your Medicare provider, please contact CHA at 888-614-5400.
Having Medicaid provides important health coverage, but sometimes there are issues with claims not being paid correctly. If you get a bill from a doctor after Medicaid was supposed to pay, don’t panic. This guide explains your rights and how to resolve Medicaid non-payment of medical bills.
Understanding Medicaid Balance Billing Rules
If a provider accepts Medicaid, they are prohibited from “balance billing” you for covered services. This means:
- They cannot charge you anything above what Medicaid already paid
- You cannot be billed for co-pays, co-insurance, deductibles, etc. that Medicaid does not cover
- The provider has to write-off the unpaid portion
There are 2 exceptions
- You signed an agreement to pay more out-of-pocket
- You were told a service wasn’t covered and agreed to pay
Why Am I Getting Bills if Medicaid Should Have Paid?
There are a few reasons why a Medicaid provider may mistakenly bill you
- They made a billing error and did not submit correctly to Medicaid
- There was an issue or dispute with the Medicaid claim
- The provider is illegally balance billing you
This is against the Medicaid rules, But many people pay these bills not knowing their rights
Tips to Resolve Medicaid Non-Payment of Bills
If you get a bill after Medicaid was used, take these steps:
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Verify it’s a valid bill – Make sure it’s not a scam or mistaken bill. Contact the provider to verify.
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Check claim status – Call Medicaid to see if a claim was submitted and processed successfully.
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Identify reason for non-payment – Ask the provider why Medicaid didn’t pay as expected. Get details on any claim issues.
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Appeal claim denial – For a denied Medicaid claim, go through the appeal process to get it paid.
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Report illegal billing – If the provider admits they balance billed you illegally, report them to Medicaid.
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Negotiate payment plan – If you agreed to pay out-of-pocket, try to work out a reasonable payment installment plan.
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Seek legal assistance – Organizations like Community Health Advocates can provide guidance to protect your rights.
Examples of Fixing Unpaid Medicaid Bills
Here are some examples of how to resolve different scenarios when Medicaid doesn’t pay:
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Billing error – The provider realizes they made a mistake submitting the claim so they re-submit properly to Medicaid and rescind the false bill.
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Non-covered service – You opted for an extra service not covered by Medicaid. You set up a fair payment plan for the out-of-pocket charge.
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Denied claim – Medicaid denied the claim as “medically unnecessary.” You appeal and provide documentation to get the claim approved and paid.
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Illegal billing – The provider keeps incorrectly billing you after getting paid by Medicaid. You report them to the state Medicaid agency for violating the balance billing ban.
Don’t Ignore Unpaid Medicaid Bills
When providers fail to follow Medicaid billing rules, it can create financial headaches and stress for you. But there are ways to remedy the situation when Medicaid doesn’t pay for healthcare services as expected. Be proactive and patient to get your bill properly resolved.
CHA can help answer your healthcare questions.
- Call our helpline at (888) 614-5400 Monday to Friday, 9am to 4pm,
- or email [email protected].
If you have Medicaid, a doctor or hospital who accepts Medicaid is prohibited from balance billing you for services that Medicaid covers. This means that the provider cannot charge you more than what Medicaid paid, unless you make a private written agreement to pay more or you were told that Medicaid does not cover the service you need and you agreed to pay out of pocket for it. If you are being balanced bill by a Medicaid provider, please contact CHA at 888-614-5400 for help.
If you have Medicare and are a Qualified Medicare Beneficiary (QMB) you are protected by federal law from balance billing by a Medicare-enrolled provider for amounts above what Medicare paid. This means you cannot be billed for any cost-sharing including co-payments or co-insurance, for services covered by Medicare. If you are being balanced billed by your Medicare provider, please contact CHA at 888-614-5400.
Do I Have To Pay Back Medicaid For Medical Expenses From My Personal Injury Settlement?
FAQ
What happens if you don’t pay medical bills in America?
There are things you can do to make sure the medical bill is correct and that you get any financial or legal help you need. If you don’t pay, you might have to deal with late fees and interest, debt collection, lawsuits, wage garnishments, and your credit score going down.
Does NC Medicaid back pay?
This is important because you can ask for Medicaid coverage to go back up to three months from the date you applied. So, if you apply for Medicaid in March and are approved, they will pay for services from December through February.
What is the timely filing limit for Alabama Medicaid?
How long do I have to file a claim with Alabama Medicaid? Most Medicaid claims must be filed within one year of the date of service, but some programs have different deadlines. Refer to your particular provider type program chapter for clarification.
Does Texas Medicaid pay retroactively?
You have to ask the Health and Human Services Commission (HHSC) for retroactive eligibility; it’s not given to you automatically. The person applying must talk to someone from HHSC about prior coverage and fill out the part of the application that talks about medical bills.
What if I am being balanced bill by a Medicaid provider?
If you are being balanced bill by a Medicaid provider, please contact CHA at 888-614-5400 for help. If you have Medicare and are a Qualified Medicare Beneficiary (QMB), a Medicare-enrolled provider cannot charge you more than Medicare paid. This is because of a federal law.
What if I can’t pay a medical bill?
Searches are limited to 75 characters. If you can’t pay a medical bill, make sure the provider got the amount right and that you do owe it before you pay. There also may be protections under federal and state law as well as financial assistance for you.
Can a Medicaid provider charge me more than Medicaid paid?
This means the provider can’t charge you more than what Medicaid paid, unless you agree in writing to pay more or were told that Medicaid doesn’t cover the service you need and agreed to pay for it yourself. If you are being balanced bill by a Medicaid provider, please contact CHA at 888-614-5400 for help.
What if my medical provider won’t stop billing me?
If the medical provider won’t stop billing you, call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users can call (877) 486-2048. Medicare can tell your provider to stop billing you and give you back any money you’ve already paid if you are a Qualified Medicare Beneficiary. Veterans: You may qualify for financial hardship assistance .
What if a medical provider asks you to pay?
If a provider asks you to pay, that’s against the law. If the medical provider won’t stop billing you, call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users can call (877) 486-2048. Medicare can tell your provider to stop billing you and give you back any money you’ve already paid if you are a Qualified Medicare Beneficiary.
What if my medical bill is already in collections?
If your provider or facility is already trying to get paid for your bill, they can’t do that anymore until the dispute process is over. You can do something if a debt collector calls you about an unexpected out-of-network medical bill or if you see a surprise medical charge on your credit report as a bad item.
