If you're enrolled in your Medicaid program or the Children’s Health Insurance Program (CHIP), here are some things to know.
For most questions, contact your state Medicaid or CHIP agency.
Using emergency services: In an emergency, you should get care from the closest hospital that can help you. The law requires providers offering emergency services to examine you to determine if your medical condition is life threatening and provide medical care until your life is no longer in danger.
Issues to take to your state Medicaid or CHIP agency include:
FILLING PRESCRIPTIONS IF YOU DON'T HAVE A CARD: If you need to fill a prescription and haven’t received your enrollment card yet, check if your pharmacy accepts Medicaid, CHIP, or your health plan. If they do, take your eligibility letter and prescription to the pharmacy. They’ll try to fill it using the information in the letter.
If they don’t have enough information, most pharmacies can give you enough medicine for 3 days. Call your Medicaid or CHIP agency or health plan for help getting the rest of your medicine.
If your pharmacy doesn’t accept Medicaid, CHIP, or your health plan, call the number in your eligibility letter to find a pharmacy you can use. You can usually find this information on the state Medicaid or CHIP agency website too.
If you received a letter telling you that you’ve been enrolled in Medicaid or CHIP, but you haven’t received an enrollment card from your state agency or one of its health plans, you should still be able to get health care services. If you need care, show your provider a copy of your eligibility letter. Your provider can verify your enrollment.
When you make an appointment for care, be sure to tell your provider that you’re enrolled in Medicaid or CHIP, or give them the name of your health plan. If you’re having trouble getting an appointment to see a doctor, call your state Medicaid or CHIP agency or your health plan’s member services department.
Whether you get services through providers in your state’s Medicaid or CHIP program or a private health insurance plan, you can ask them to reconsider paying the bill. This is called an appeal.
Your state Medicaid or CHIP agency’s website will have information on how to file an appeal. Or you can call your state agency or your health plan’s member services number. They’ll help you with your appeal.
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