Medicaid FAQ 1. What do I do if I have lost my plastic Medicaid card or never received one? You may contact Iowa Medicaid Member Services by phone or e-mail. The phone number is 800-338-8366 or locally in the Des Moines area at 515- 725-1003. The e-mail address is IMEMemberServices@dhs.state.ia.us. You also can contact your IM worker at your local DHS office. The new cards should be sent out within 14 days of your request. 2. How do I verify if I am currently eligible for Iowa Medicaid? You may contact Iowa Medicaid Member Services by phone or e-mail. The phone number is 800-338-8366 or locally at 515-725-1003. The e-mail address is IMEMemberServices@dhs.state.ia.us. 3. How do I know if a service is covered or not? All services are based on medical necessity. Your doctor is the best person to determine the medical necessity of a procedure in which you need. The provider will need to contact Provider Services to explain what service you are in need of. Provider Services will then help your doctor to determine if this service is covered for you. 4. Who do I contact if I am cancelled from Iowa Medicaid? Contact your IM worker at your local Department of Human Services. Your IM worker is the only one that can assist you with questions about your eligibility. 5. I need a certificate showing the dates I was eligible for Iowa Medicaid. How do I get one? You may contact Iowa Medicaid Member Services by phone or e-mail. The phone number is 800-338-8366 or locally at 515-725-1003. The e-mail address is IMEMemberServices@dhs.state.ia.us. You will receive it within 5 – 7 business days from the date of your request. 6. I just had a baby how do I enroll them with Iowa Medicaid? You will want to contact your IM worker at your local Department of Human Services as soon as possible. The IM worker will assist you in enrolling your baby with Iowa Medicaid. 7. I received a letter saying I can sign up for the Medicare Savings Program, what is that? If you qualify, Iowa Medicaid can help assist with paying your premiums for you Medicare Part A and/or Part B. There are two programs that qualify under the Medicare Savings Program. They are Qualified Medicare Beneficiary (QMB) and Specified Low – Income Medicare Beneficiary (SLMB). QMB will pay for your Medicare premiums, co-pays and deductibles. SLMB will only pay for your Medicare Part B Premiums. 8. How do I sign up for the Medicare savings program? This is done through the local Department of Human Services. If you do not know how to get in contact with the local office a list of phone numbers is available on our website, www.ime.state.ia.us . You may also contact Iowa Medicaid Member Services by phone or e-mail. The phone number is 800-338-8366 or locally at 515-725-1003. The e-mail address is IMEMemberServices@dhs.state.ia.us to inquire as to the phone number or address for your local DHS. 9. How do I check to see if I have met my spenddown for Iowa Medicaid? Contact Iowa Medicaid Member Services by phone or e-mail. The phone number is 800-338-8366 or locally at 515-725-1003. The e-mail address is IMEMemberServices@dhs.state.ia.us. 10. What is the trauma lead letter and do I have to fill it out? When you visit any physician or hospital and a claim is sent to Medicaid with a diagnosis indicating there may have been an injury involved. The Medicaid system automatically generates this letter so that Medicaid can verify if the injury was caused by an accident in which someone else may be responsible. You are required to fill it out and return to Medicaid within 10 days. Also, you may receive more then one as Medicaid may receive more then one claim for this incident from multiple providers; each letter is required to be sent back in within 10 business days. 11. I need copies of bills that Iowa Medicaid paid that should have been paid by another insurance, how do I get them? The Iowa Medicaid Member Services unit can place a claims history request for you. Please contact Iowa Medicaid Member Services by phone or email. The phone number is 800-338-8366 or locally at 515-725-1003. The e-mail address is IMEMemberServices@dhs.state.ia.us. You should receive the claims history within 5 – 7 business days for your request. If you need specific copies of bills you will need to contact your provider. Iowa Medicaid does not have copies of your bills. If you need copies of the bills due to an accident or injury caused by another party, your request will be sent on to Iowa Medicaid’s Lien Recovery Department. Someone from the Lien Recovery department will contact you to gather additional information. 12. I am pregnant and being charged co-pays. What should I do? First, make sure the provider is aware that you are pregnant. If your provider still continues to bill you for co-pays contact Iowa Medicaid Member Services by phone or e-mail. The phone number is 800-338-8366 or locally at 515-725-1003. The e-mail address is IMEMemberServices@dhs.state.ia.us. Iowa Medicaid Member Services will then contact the provider charging you co-pays to explain that you should not be charged for any co-pays while you are pregnant. 13. My child under 21 keeps being charged co-pays, what can I do? First, make sure your provider is aware that your child is under 21 and should not be charged for any co-pays. If this does not help then please contact the Iowa Medicaid Member Services billing department to have a bill inquiry taken for you. This process can take up to 30 days and you will receive a response by mail advising you of the outcome. 14. I am receiving a bill and I was eligible at the time of service, what do I do? Please contact the Iowa Medicaid Member Services billing department by phone, e-mail, or letter. The phone number is 800-338-8366 or locally 515- 725-1003. The e-mail address is IMEMemberServices@dhs.state.ia.us. The address is: Iowa Medicaid Enterprise Member Services PO Box 36510 Des Moines, IA 50315 Iowa Medicaid Member Services will begin a bill inquiry to research the reason you are being billed. The process can take up to 30 days and you will receive response by mail. 15. How do I get reimbursed for expenses paid out of pocket? Iowa Medicaid does not reimburse members. You will want to contact the Iowa Medicaid Member Services billing department so that the charges can be looked into. This process can take up to 30 days and you will receive a response by mail advising you of the outcome. 16. How long does it take for a prior authorization (PA) to be approved? If you are trying to get a PA for a prescription it generally takes 24 – 48 hours, excluding weekends for a decision. If you are trying to get a PA for a medical service it could take up to 60 days. Generally, if your provider provides all information to Iowa Medicaid the timeframe is generally 10 – 15 business days. 17. I have been getting a RX for a long time without needing approval, why do I need approval now? The Preferred Drug List for Iowa Medicaid changes every three months. Prescriptions you may have gotten in the past without a prior authorization may change to require you receive a prior authorization before it can be filled. 18. My PA was not approved, how do I find out why? You will want to contact your doctor that had made the prior authorization request. Your doctors will either already know or they have access to the department that handles PA’s. Also, you will receive a denial letter in the mail explaining the reason the PA was denied which offers you the Right to Appeal. 19. If I am eligible for both Medicare & Medicaid, why doesn’t Medicaid pay for my prescriptions any longer? Members that are eligible for both Medicare and Iowa Medicaid are required to be enrolled with a Medicare Part D plan. Your Medicare Part D plan is now responsible for your prescription drugs. Iowa Medicaid will now only cover psychotropic drugs (mental health medications) and some cold medicines. If you are having trouble getting one of your daily maintenance drugs covered you will need to contact your Medicare Part D plan for assistance. 20. How do I find out what medications are covered? You may obtain this information from either your pharmacy or the provider that wrote the prescription for you. 21. I can’t get my RX filled at the pharmacy. What should I do? First, ask the pharmacist for the reason it cannot be filled. The pharmacist has that information immediately. If that does not work, contact the provider that wrote the prescription. The provider can contact Pharmacy Helpdesk to find out what the problem with the prescription is. 22. My friend has different services covered then I do, why is that? Members on Iowa Medicaid do not necessarily have the same types of coverage. It depends on which program within Iowa Medicaid you have been enrolled in. Coverage of service is also based on medical necessity determined by your provider. 23. Can I see providers that are out of state? Yes. You must first make sure that they are signed up with Iowa Medicaid. You can do this by calling Iowa Medicaid Member Services at 800-338-8366 or locally 515-725-1003. Also, there is a list available here on the website, www.ime.state.ia.us When you first pull up the site scroll down to the gray box in the bottom right corner. Click on the third bulletin that says search for a provider. Also, even though a provider is on the list as accepting Iowa Medicaid you must also check with them ahead of time to verify that they are accepting new Iowa Medicaid patients. 24. If I am out of state how do I find a provider that will accept Iowa Medicaid? There is a list of the available out of state providers available on our website, www.ime.state.ia.us . You may also contact Iowa Medicaid Member Services for more information. When you first pull up the site scroll down to the gray box in the bottom right corner. Click on the fourth bullet that says search for a provider. 25. I am being told I have another insurance listed on my file. How do I get that removed? You may contact Iowa Medicaid Member Services by phone or e-mail. The phone number is 800-338-8366 or locally at 515-725-1003. The e-mail address is IMEMemberServices@dhs.state.ia.us. It will take up to 10 business days from the date Iowa Medicaid Member Services receives your request to have the other insurance updated. 26. How do I find out the insurance information for an absent parent insurance policy? Iowa Medicaid Member Services is unable to release this information. You will need to contact Child Support Recovery at 1-888-229-9223. 27. Why do I have to be on the Managed Health Care program? Managed Health Care (MHC) is a program designed to help you stay healthy. MHC works by making sure you have a medical provider you feel good about and one with which you can build a strong relationship. This will allow your provider to get to know you, your medical history, and help you stay healthy by knowing what care is best for you. To choose your Managed Health Care provider you may contact Iowa Medicaid Member Services. 28. Why can’t I have my obstetrician (OB) doctor as my primary care physician? It depends. Each physician must sign up to be a Managed Healthcare provider. Most OB doctors choose not to do so because they are a specialist. This does not mean you cannot see your OB; this means you must choose a family doctor enrolled with MHC who is willing to refer you to your OB doctor. 29. How do I change my MediPASS provider? You may contact Iowa Medicaid Member Services by phone or e-mail. The phone number is 800-338-8366 or locally at 515-725-1003. The e-mail address is IMEMemberServices@dhs.state.ia.us. Also, you may fill out the yellow enrollment form that was mailed out to you when you first enrolled with Iowa Medicaid. In order for your provider selection to take effect for the following month you must contact the Member Services office by the 15th of the previous month. 30. What is the difference between MediPASS and HMO (Coventry)? Currently the only HMO available is Coventry, this is only available for members living in Black Hawk, Bremer, Butler, or Grundy counties. MediPASS and Coventry are very similar. Both require you choose one primary health care doctor and both require you receive referrals to go to a medical specialist. The main difference between the programs is the providers in which you access care. While on the MediPASS program you may be referred to any provider that accepts Iowa Medicaid. HMO members may be referred to providers that are enrolled with the HMO. 31. What services don’t I need a referral for? There are several services that do not require a referral. These services are: • Dental Services • Chiropractic services • Ambulance services (must be medically necessary) • Family planning services • Emergent services • Vision services • Prescription services • Early Periodic Screening, Diagnosis & Treatment (EPSDT) for individuals under the age of 21. 32. How does the smoking cessation program work? • You must first make an appointment with your provider. You and your physician will work together to decide the best plan for you. • The following smoking cessation medications are available: Chantix™ Buproprion (generic for Zyban) Nicotine replacement patches Or Nicotine gum • If your provider chooses Chantix™, the over the counter nicotine replacement patches, or gum you will be required to actively participate in counseling with Quitline Iowa. • You will be asked to fill out a prior authorization form at your provider’s office. They will fax this form over to Quitline Iowa. • Quitline Iowa will contact you to gather information and enroll you in the Quitline Iowa counseling program. Then they will send a prior authorization request to Iowa Medicaid for your medication. • Once Iowa Medicaid has approved the prior authorization of the medication it will be available at your pharmacy. 33. How do I get reimbursed for transportation expenses? Medicaid covers transportation to receive necessary medical care if the specific type of care you require is not available in the community in which the member resides. The members should check with their local DHS office before they arrange transportation since there are certain conditions that must be met in order for services to be reimbursed by Medicaid.