Medicaid Billing

This is an informational survey that asks questions about Medicaid billing getting sent to collections. 

All information will kept confidential and will only be used for purposes of determining if there is a violation of Medicaid policy. 

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* 1. Please fill out your contact information. 

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* 2. Medicaid ID Number

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* 3. Were you on Medicaid during the time the service took place? 

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* 4. Did you communicate to your medical provider that you were on Medicaid? If yes, please state if you told them before or after your visit. If you didn't communicate that you were on Medicaid, was your medical provider otherwise aware (e.g. they communicated to you that they knew you had Medicaid).

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* 5. What is the date that the collections activity took place? 

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* 6. Did you get a bill before you got a collection notice? If yes, how much was it for? 

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* 7. If you answered yes to the previous question, did you contact your provider after you received the billing notice? Please state how you contacted the provider (phone, letter, email).

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* 8. Did you contact the collection agency? If so, describe how you did so (phone, email, letter). 

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* 9. Did you take other steps to address the situation? If so, please state how you did so.

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* 10. Who was your service provider?

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* 11. What was the date of your service? 

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* 12. What was the service? 

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* 13. Did your medical provider respond? If so, please describe how.

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* 14. Did your collection agency respond? If so, please describe how.

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