Recipient Reimbursement

Getting Money Back for Medical Expenses

The team in charge of giving money back to people on Medicaid who pay for medical expenses themselves before they knew they had Medicaid is called the Recipient Reimbursement Unit.  If you signed up for Medicaid on or after February 15, 1995, you might get money back for medical things you paid for between when you got approved for Medicaid and when you got your first Medicaid Eligibility Card (or when your card got reactivated).

To get money back, you must show:   

1. The bill with:
   • Your name
   • The doctor or facility's name, address and phone number
   • Date of service
   • Procedure and Diagnosis codes (you can ask your provider if you don't know this)
   • How much you paid
   • If private insurance paid, you need proof of what they paid, like an Explanation of Benefits (EOB)
   • If you got Durable Medical Equipment (DME), you need a note from your doctor showing proof of medical necessity and a prescription for each item, if one was issued.
   • If you got dental work, you need diagnosis and procedure codes for each tooth.
   • If you got medicine, you need information about the prescription, including: the date the prescription was filled, the National Drug Code (NDC), quantity dispensed, and retail cash price, if insurance or discount card was used, or the amount paid by the third party entity.
2. Proof you paid for the bill.  If it was paid by someone else, proof that you are still liable to pay back the person who paid the bill.

Submitting Your Claim

LDH/MMIS/Retroactive Reimbursement Unit
P.O. Box 91030
Baton Rouge, LA 70821-9030
or Medicaid.RecipientReimbursement@la.gov. 

Contact us at 1(866) 640-3905 or (225) 342-1739.

If they need more information from you, they'll send you a form to fill out.  You have fifteen days to send back the inforamation.  If you need more time, you can ask, but you can't get more than fifteen extra days.  IF you don't send the information or ask for more time, they will not be able to give you money back. 

 

Getting Paid

If you follow all of the rules, they'll send you a check for the most Medicaid will pay, and they'll tell you why you're getting the money.  The Notice of Recipient Reimbursement Decision explains the reimbursement decision.  You will get back money at the Medicaid price, but they'll take out any payments made from someone else (like insurance) first.

If you do not follow the rules, a Notice of Reimbursement Decision will be sent to tell you why they are not going to give you money back.  You can appeal the decision, if you think there was an error.