Bill from May 2025

[u/monsieurvampy]

Summary: Managed Medicaid Plan. Contractual Denial. Member Responsibility Zero. Provider Billed.

Today, I just received a bill for a pulse oximetry from 5/17/25 for $38.00. This appears to be the first invoice as its not past due. I've checked my EOB and it indicates Remark 15. Contractual Denial. This service is not covered by your plan.

Total Member Responsibility is 0.00.

I probably signed something back in May 2025 that I would be responsible but am I actually responsible?

$38 dollars is not a lot of money generally but for me right now and for the foreseeable future it is.

Is it easier to just pony up the cash or to call them and be like "insurance says zero"? What are even the options here? Most of the time whenever I see an EOB like this, I don't get a bill for it. This insurance company doesn't say denial or approved for EOBs, everything is PROCESSED. It's the best insurance company available in my area. It only services Western New York. Company is based in Kansas, or at least that's where they send billing from.

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[u/throwfarfaraway1818]

Providers cant legally balance bill Medicaid patients. Even if you signed something indicating you would pay, you dont owe that money. Call Medicaid and tell them the provider is trying to bill you and they can take care of it.

[u/No-Produce-6720]

The only factor that truly matters here is that this is a Medicaid plan. Legally and regulatorilally, as well as contractually, providers cannot bill a Medicaid recipient for any services.

There are just a very few exceptions to that rule, however. As a Medicaid recipient, the only time you can be charged for service is when you acknowledge in advance and in writing that you are paying cash for a non covered service.

If you agreed in writing and prior to your pulse ox, then yes, you can be billed. Otherwise, as a Medicaid recipient, you are contractually prohibited from being a self pay patient. Medicaid eligibility is determined by income, and once it's been established that you need assistance, you are not allowed to pay out of pocket for anything, unless the procedure that I described above has taken place.

You need to contact your Medicaid plan and file a balance billing grievance. They will handle things from there.

Yes, the bill is small, but please, do not pay it!

[u/AlternativeZone5089]

If your EOB says that you owe zero and your provider is in netwok with your plan then you owe nothing and should send a certified letter explaining this along with a copy of the bill and the eob.