Billing problems can come up if the provider does not accept Medicaid. It is your responsibility to find out if a provider you are supposed to see takes Medicaid.
If the provider usually accepts Medicaid, but doesn’t want to bill Medicaid for a certain service, they must tell you that they won’t bill Medicaid before you get the service. They have to tell you in writing on their letterhead and they have to get you to sign the letter before you get the service.
Be very careful before signing anything. If you aren’t sure what you’re signing, ask the provider to explain exactly what you are agreeing to when you sign.
The information in sections 6.3, 6.4 and 6.5 (pages 35-36) of the Vermont Providers Manual tells you exactly what the providers must do and what they can’t do.
If providers accept Medicaid, they cannot bill you for costs above the Medicaid payment rate. This is called "balance billing." It is not allowed. If you think your provider is billing you for the amount Medicaid will not pay, fill out the Health Care Fraud and Abuse Referral Form and send it to the Department of Vermont Health Access (DVHA.) You will find the mailing address, fax number and email address on the form.
Medicaid Pays Last
If you have other insurance and Medicaid, Medicaid always pays last. See our Coordination of Benefits section for more information.