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
- 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
- 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
- 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 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.
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