If you get a bill medical care received in the past 12 months, for which you presentated your medical ID card, call the provider to see why, then send that bill to:
Member Services
P.O. Box 2002
Charleston, West Virginia 25327-2002
Or call 1-888-483-0797 or 304-348-3365
If you have questions about Medicaid Coverage, call Client Services at:
1-800-642-8589
304-558-2400
Hearing Impaired: 304-558-3515
If you have questions about Managed Care call: 1-800-449-8466
Services provided out of state must be prior-approved by Medicaid or care for a medical emergency.
Medicaid patients MUST PAY for:
Services NOT covered by Medicaid:
- After Medicaid benefit is exhausted.
- Not medically necessary.
- Not approved by the Managed Care provider (except for medical emergency).
- Convenience items not related to the medical care.
- Services providedj when a patient is not eligible.
- Services from a provider who tells a patient that he/she will not bill Medicaid before the service is provided.
- Services provided when the patient refuses to use other insurance.
- Services provided when the patient does not follow the plan provisions of their primary insurance, which includes but is not limited to utilizing in-network providers and following all pre-certification guidelines.
- Any Medicaid co-payments that apply to the services the patient receives.
Medicaid members must not be billed, or otherwise held responsbile for:
1. Billings denied for provider error. For example:
- Claims filed more than one year after date of service.
- Wrongful billing or missing information.
2. Billings denied because provider did not:
- Follow procedures.
- Get approval from Medicaid or the managed care provider, if applicable.
- Notify the member before the service is provided that it is not covered by Medicaid.
3. Charges remaining after payments by insurance or Medicaid.
4. Fees for missed appointments.
