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⭒ CANHR Advocate Did You Know Articles

Medi-Cal applicants can seek reimbursement for unpaid medical bills

Many Medi-Cal applicants have unpaid medical bills prior to their application submission. Some applicants paid for medical services and, in other cases, family member’s have paid these bills hoping to be reimbursed once the applicant is approved for Medi-Cal. If you would have been eligible for Medi-Cal during those 90 days prior to application submission you may be reimbursed for those expenses.

To cover these expenses, make sure to check “yes” on Question #53, found in Section 7 on the Medi-Cal application. According to Welfare and Institutions Code §14019.3, the claim must also meet the following criteria:

1. The service was a covered benefit under the Medi-Cal program.

2. The provider was an enrolled Medi-Cal provider at the time the service was rendered.

3. The service was ordered by a health care provider, within the scope of his or her practice.

4. The beneficiary is eligible for reimbursement, as specified in subdivision (a).

5. The reimbursement shall be the amount paid by the beneficiary, not to exceed the rate established for that service under the Medi-Cal program.