Help for Qualified Medicare Beneficiaries (QMB) Being Billed

If you are on Medicaid as a Qualified Medicare Beneficiary (QMB), your medical provider should not “balance bill” you.  This means that your pharmacy, doctor, or hospital should not ask you to pay the portion of your bill not covered by Medicare, including deductibles, coinsurance, and copayments.   This practice is prohibited by federal law.  Providers who are enrolled with the District of Columbia Medicaid program must bill Medicaid for any portion not covered by Medicare.  If your medical provider is not enrolled with the District of Columbia Medicaid program, it must accept the Medicare payment as payment in full and cannot bill you for any remaining amount on your bill.


In the event that you have Medicaid QMB coverage and Medicare, and your medical provider is inappropriately billing you, you may wish to send a letter to the provider requesting it to stop balance-billing you and informing the provider that its actions are illegal.  You should also submit a claim for reimbursement to the District of Columbia’s Department of Health Care Finance requesting that it pay the provider or inform the provider that it should stop billing you.


The following guidance materials can help you get started.


If you are a QMB and your Part B premiums are incorrectly being deducted from your Social Security check, call the District of Columbia Health Care Ombudsman’s  Office  at  202-724-7491 for assistance.  You can also obtain free legal assistance from the Health insurance Counseling Project at the George Washington University Law School at 202-994-6272.

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