I have NJ Family Care, which is the HMO version of NJ State Medicaid, as I sit here taking care of mom. My HMO has never sent me an EOB for any claim. Does anyone else have this problem?

A stupid question...did the doctor's billing office bill medicaid? We had this with a small amt nephew was billed. I called the office and found Medicaid had not been billed. I am under the impression that a doctor cannot charge a medicaid recipient. A Medicaid recipient cannot pay a doctor out if pocket unless its a co-pay or deductible.

My nephew was going to a Neurologist while he was on his guardians insurance. Once on Medicaid the Neurologist did not except Medicaid. I asked if I could pay for the visit and was told no, Drs are not allowed to except payment from Medicaid recipients. When nephew was OKd for SSD, he then received Medicare and Medicaid as his secondary. The Neurologist then took him back. I notice the Medicare Statements show a balance owed the Dr. but nephew has never been billed for it.

I really think this is a billing problem. Someone has not credited your account with the doctor if u show they were paid. If it was submitted and not paid, that is not your problem. Its up to the billing clerk to find out from the insurance company why they were not paid. I have had insurance companies call a doctor for me telling them the claim was processed and paid. They have the check info. You have a Medicaid caseworker, get him/her involved. Coding is the billing clerks problem. Its the clerks job to get the doctor his money. A coding error is not uncommon. Clerk just needs to reenter the claim with the propper code.

Ask ur caseworker if I am correct about a Dr. not being able to bill you as a Medicaid recipient. A doctor excepting Medicare and Medicaid have to except what they receive from them. There is no billing the patient for money not received.

Me, I would call the billing office and tell them as a Medicaid recipient you are not responsible for any charges. If they have not been paid by Medicaid, its up to them to find out why not. And I have asked this question from my insurance provider. Do I do the research or the billing clerk and I was told the billing clerk.

I may also change providers if this Amerigroup is not willing to call the Dr and straighten this out for you. My nephew has Horizon B/C B/S and I have B/C B/S thru my husband's union and have had no problem with them helping me. Once with fraud on an employee of the doctor's.

Press charges? Why on earth would you do that?

If the names are on different pages, you just print out all the pages. Or copy and paste the document into an email.

James, the "secret" reason is that it costs money to generate an EOB.

Anthem, Amerigroup's parent company has a lovely tutorial that medical professionals can use to see if they've been paid. If you Google Amerigroup EOB, you'll see it.

Why can't you print out what is shown in your online account and send that to the ER docs?

James, if you are in a "capitated" plan, the state is paying a fixed amount for your care and there are no EOBs.

if I recall your previous posts, you have no income or assets and are therefore judgement proof..

Consider sending a letter to the medical practice stating that Amerigroup is your insurance carrier and any billing issues will need to be taken up with them. And that have no income or assets..

Send copies of what you write to Amerigroup and the NJ State Insurance Commission.

Conside contacting your local state representative to resolve this.

James, send the hospital a copy of your Medicaid card. That should be all you need.

https://www.state.nj.us/humanservices/dmahs/info/resources/care/

The above link may help you navigate the NJ Medicaid system and answer some questions. Try calling Legal Aid, they may have an answer for you regarding the 'legality' of Amerigroup having to provide you with an EOB for services rendered. The laws may be different pertaining to Medicaid requirements, IDK.

Good luck.

My nephew is on NJ care and Medicare. He gets his Medicare statements but not statements from Horizon who is his medicaid insurance. Does it really matter? Everything gets paid. You owe nothing unless u have co-pays and deductables. My nephew doesn't have these.