Medicare is a program that provides healthcare coverage to seniors and other persons with disabilities. But, if you need to file a claim with Medicare, it might be difficult figuring out how to go about doing so.
This article will give you all the details you need if your doctor has not filed a claim for Medicare yet.
Are You Responsible for Claims?
Hospitals and doctors are normally responsible for filing insurance claims, including Medicare claims. You can check your Medicare Summary Notice or online account to make sure the appropriate information is there and is being filed at the right time.
A claim has to be filed within 12 months of you receiving the services. Otherwise, Medicare can’t pay its portion of the costs.
When Would You Need to File?
You can personally get in touch with your doctor so they can file the claim on time, but if they do not, you may have to take on the responsibility. Some doctors or healthcare providers claim that they “don’t accept assignment.” While a “non-participating provider” does not accept Medicare assignment, they DO accept Medicare. Because they do not accept assignment, they are allowed to “balance bill” up to 15% of the Medicare-approved amount. That 15% is referred to as the Part B Excess Charge.
Keep in mind that if you’re just enrolled in Original Medicare, it is required that your doctor or supplier files the claim. If you have Medicare Advantage, then they don’t have to because Medicare already pays a certain amount each month to the insurance company.
If you need to file a claim with Medicare yourself, then the next section will help guide you through that process.
How Can I File a Claim?
The fastest and best way to file a Medicare claim is directly on the website medicare.gov or by calling 1-800-MEDICARE.
The following items are necessary to file your claim:
- A Patient Request for Medical Payment form (CMS-1490S)
- An itemized bill and letter explaining your reason for submitting the claim
After you have completed this process, submit your documentation with any supporting documents related to your claim. You can then receive acknowledgment of your claim.
Get Help From an Experienced Agent Today!
Medicare is a complicated program, so it’s best to have an agent you can trust. Our experienced agents at Turning 65 Solutions are here to provide you with the best services as we can answer any question you may have regarding Medicare coverage or filing claims, and we will be right by your side every step of the way!
Give us a call today for more information on what we can do for you!