17.7 Remaining Deductible

When the member receives a medical bill that is equal to or greater than the amount he or she still owes on the deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan. , he or she can be certified for BadgerCare Plus. However, he or she is still responsible for the part of the bill that equals the deductible. BadgerCare Plus will consider the remainder of the bill for payment. See (Process Help, Chapter 19 Medicaid Deductible).

A BadgerCare Plus Remaining Deductible Update (F-10109) must be sent to the fiscal agency indicating the amount of the bill that the member owes. The Fiscal Agent subtracts this amount from the bill and BadgerCare Plus pays the rest.

Fill out the BadgerCare Plus Remaining Deductible Update (F-10109) only if:

A BadgerCare Plus certified provider has provided the billed services.

The person, having met the deductible, is being certified. If he or she is not being certified, BadgerCare Plus will not pay any of the bill.

The date of the bill is the date the deductible was met. Since the member is not eligible until he or she has met the deductible, he or she still owes for all bills prior to that date.

This page last updated in Release Number: 07-01

Release Date: 10/29/07

Effective Date: 02/01/08

The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Publication Number: P-10171