Medicaid: Underutilized and
misunderstood
By Stacey Kiehn, Public Information Officer, THHS
In this final article discussing Medicaid, the
focus is on individual health care and how it is built on a foundation
of responsibility for personal wellness. As a Medicaid recipient your
responsibility is to assist your health care provider in giving the
best care by:
• Calling the "Nurse First"
advice line first. This service is available 24 hours-a-day, 7
days-a-week. By utilizing this program, you save time, money and grief
due to prolonged waiting, making the best use of the health care
system. For more information regarding this service, call the Medicaid
Help Line at 1-800-362-8312.
• Do not use an ambulance or the emergency room if it's not an
emergency. Emergency ambulance services are covered for emergency
ground or air transports only. If it is not an emergency, Medicaid will
not cover the transport charges.
• Call ahead for an appointment - ask if your provider accepts
Medicaid. Also ask if Medicaid covers what you need. Remember to obtain
your PASSPORT providers approval, if you are on the PASSPORT coverage
program.
• Keep your appointments and be on time. Call ahead of time if
you are going to be late or can't keep your appointment.
• Keep your health care provider informed. Tell them about any
signs of trouble, pain, allergies, or changes you have noticed.
• Always have your prescriptions filled at the same pharmacy.
The pharmacy will be able to tell you if a drug combination will have
problems or side effects.
• Take time to decide about having a treatment or procedure
before it happens in non-emergent situations. Discuss your options with
your health care provider. For some procedures, your provider will need Medicaid approval before
the services can be provided.
• Don't sign anything you don't understand. Ask questions
until you have a clear idea of what is being conveyed to you.
• Pay your health care provider any money you receive from
your insurance or other payers for medical expenses.
• Use Medicaid wisely. If you misuse the benefit, you could
lose your freedom to choose your own health care provider and pharmacy.
Along with knowing your responsibilities as a
Medicaid beneficiary, it is good to know what your rights are as well.
As the beneficiary, you have the right to:
• Expect the same quality of medical care available to the
general public.
• Be treated politely and with respect by the health care
providers and their staff.
• Participate in decisions about your health care.
• Understand your medical conditions.
• Discuss the treatment your provider advises before it
happens.
• Receive information on treatment options.
• Refuse treatment to the extent of the law.
• Discuss possible results with your provider before accepting
or refusing treatment.
• Talk in confidence with your health care provider and expect
the conversation and your medical records to be kept private.
• Make a complaint about Medicaid and receive an answer.
• Know what medical services are covered or paid for by
Medicaid.
Medicaid services must be medically necessary;
provided by a health care provider accepting Medicaid; and on the list
of Medicaid covered services. There are two forms of benefit coverage
available:
• Full Benefits: meaning you are eligible for all services
that Medicaid covers if medically necessary.
• Basic Benefits: meaning there are some services that are not
paid for by Medicaid, except in the case of an emergency, or where a
job requires the service (this must be discussed with your Eligibility
Case Manager).
To inquire about potential Medicaid eligibility,
you may contact one of the following CSKT Tribal Health Alternate
Resource Specialists:
Applicant last name beginning with A-L; Betty Steele (406) 745-3525
ext. 5052
Applicant last name beginning with M-Z; Diane Matt (406) 745-3525 ext.
5027
* General Medicaid Help Line: (800) 362-8312
* Montana Medicaid Help Line, P.O. Box 254, Helena, MT 59624-0254
Toll-free telephone: (800) 362-8312
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