Department of Human Services WV Bureau for Medical Services
Department of Human Services
WV Bureau for Medical Services
Department of Human Services
WV Bureau for Medical Services

Member Liability

If you get a bill medical care received in the past 12 months, for which you presentated your medical ID card, call the provider to see why, then send that bill to:
Member Services
P.O. Box 2002
Charleston, West Virginia 25327-2002
Or call 1-888-483-0797 or 304-348-3365
If you have questions about Medicaid Coverage, call Client Services at: 
Hearing Impaired:  304-558-3515
  • If you have questions about Managed Care call:  1-800-449-8466
  • Services provided out of state must be:prior approved by Medicaid or care for a medical emergency

Medicaid patients MUST PAY for:

Services NOT covered by Medicaid:

  • After Medicaid benefit is exhausted.
  • Not medically necessary.
  • Not approved by the Managed Care provider (except for medical emergency).
  • Convenience items not related to the medical care.
  • Services providedj when a patient is not eligible.
  • Services from a provider who tells a patient that he/she will not bill Medicaid before the service is provided.
  • Services provided when the patient refuses to use other insurance.
  • Services provided when the patient does not follow the plan provisions of their primary insurance, which includes but is not limited to utilizing in-network providers and following all pre-certification guidelines.


  • Any Medicaid co-payments that apply to the services the patient receives.


Medicaid members must not be billed, or otherwise held responsbile for:

1.  Billings denied for provider error.  For example:

  • Claims filed more than one year after date of service.
  • Wrongful billing or missing information.

2.  Billings denied because provider did not:

  • Follow procedures.
  • Get approval from Medicaid or the managed care provider, if applicable.
  • Notify the member before the service is provided that it is not covered by Medicaid.

3.  Charges remaining after payments by insurance or Medicaid.

4.  Fees for missed appointments.