Your doctor or other health care provider sends medical bills to Medicaid or ARKids First after treating you. If you get a bill, you might or might not have to pay it.
You can use these guidelines to find out, or call
1-800-482-5431 (Medicaid) or 1-888-474-8275 (ARKids First).
- Some treatments need approval from Medicaid or ARKids First before the treatment is performed. If your provider does not ask for this approval, Medicaid or ARKids First will not pay the charge, and you do not have to pay it either.
- You do not have to pay for services you did not need and did not choose to receive. If you choose to have a service you do not need, you will have to pay.
- Medicaid and ARKids First have agreed to pay certain amounts for certain services, and your doctor has agreed to accept these amounts. If your doctor charges more than the allowed amount for a certain service, you do not have to pay the difference.
- If Medicaid or ARKids First does not pay a charge because the doctor bills it incorrectly, you do not have to pay it either.
- You do not have to submit a Medicaid or ARKids First claim form. If a provider agrees to bill Medicaid or ARKids First for services you receive, the provider cannot charge you. Before you receive care, always ask if your doctor will bill Medicaid or ARKids First.
Charges you will have to pay:
- You may have to pay some fees, called co-payments, co-insurance and deductible amounts.
- If you do not tell your doctor or other provider that you are on Medicaid or ARKids First before you get medical treatment, the provider may bill you.
- If Medicaid or ARKids First does not cover a service that you receive, you will have to pay for it.
- You will have to pay for services that are beyond your benefit limit. For example, if you get more prescription drugs than your plan allows, you will have to pay for each prescription above the limit.
- Doctors do not have to bill Medicaid or ARKids First, even if they are Medicaid or ARKids First providers. Before you get a service or treatment for you or your child, ask if it will be billed to Medicaid or ARKids First . If it will not, the doctor has to tell you. If you still want the treatment, you may have to pay for it yourself. Or, you can find another doctor who will bill Medicaid or ARKids First.
- If your situation changes and you are no longer eligible for Medicaid or ARKids First, you will have to pay your medical bills.
- If your Medicaid eligibility is “retroactive” (it applies to services you have received in the past), you must tell your providers this when you get your Medicaid or ARKids First card. Otherwise, you will have to pay for past services.
- If you have a Medicaid “spend-down,” you must pay any charges from before the day the spend-down started. You may have an amount to pay on the first day of your spend-down eligibility.