If you have original Medicare Parts A and B, the law requires the doctors, hospital and suppliers to file Medicare claims for the medicare approved services and medical supplies provided.
If you have a Medicare Advantage plan, either an HMO or PPO, these plans do not have claims because Medicare pays these private insurance companies a set dollar amount each month.
Claims must be sent to Medicare within 12 months of the service or supply date. If the claim is not sent within the one year limit, the Medicare claim will not be paid. As a Medicare member you will receive a “Medical Summary Notice” every three months (quarterly) and this notice will keep you up to date with what medical clams have been approved and paid. If a certain claim has not been sent to Medicare contact the doctor providing the service and tell them to submit the claim.
If for some reason the doctor has not submitted the claim to Medicare and the one year time limit is approaching you can contact Medicare (1-800-633-4227). Medicare may have you submit a claim yourself, you can print the claim form here. This may the only situation you will need to submit a claim form to Medicare.
What to submit to Medicare:
- The Medicare Claim form
- The itemized bill from the doctors office or supplier.
- A letter explaining why you are submitting the claim yourself. Most likely because the doctors office could not or would not within a timely manner.
- Any other relevant material related to the claim.
Send the claim form and supporting material to the address provided on the Medicare Claim Form.
If you have Original Medicare and a Medicare Supplement policy, Once the claim is filed with Medicare, Medicare will notify the supplement company to pay their portion. You do not need to contact the supplement company.
Remember if you have Original Medicare and no other coverage, you are responsible for the $1,408 60 day hospital deductible. This is not an annual deductible. There is a new $1,408 ‘benefit period’ deductible every 60 day. Also for Part B (outpatient) your portions are; $198 annual deductible then 20% of all outpatient charges.
If you have any questions regarding claims or Medicare plan options, please feel free to contact me.