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Maintained by Northwest Justice Project
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Billing and Medicaid (Apple Health)

Northwest Justice Project

Read this if your medical provider didn't bill Medicaid for services when you think they should have. Includes form letters you can use to try to resolve the situation.

Contents

  1. Protection from billing
  2. You didn’t sign
  3. Out-of-state services
  4. Canadian providers
  5. Noncovered services
  6. Provider doesn’t take Medicaid
  7. Cost sharing
  8. Managed Care Organization (MCO)
  9. Third parties
  10. Dates not covered
  11. Form letters
View All Contents (PDF)

1. Protection from billing

If you’re on Medicaid, in Washington State called Apple Health, a medical provider usually can’t bill you, or someone related to you, such as your family, a friend, or helper, for services. Providers who take part in Apple Health must accept payment from the agency as payment in full. 

  • A provider can’t bill you for the cost of services over and above what Apple Health pays.  
  • A provider generally can’t bill you for any service Apple Health covers even if the provider hasn’t gotten payment from Apple Health or your managed care provider. 

There are exceptions to these rules. This guide discusses the exceptions. If no exception applies to you, the provider can’t bill you. 

If the provider tries to bill you anyway, try using one of our form letters. And try to talk to a lawyer.

2. You didn’t sign