learn how to file a Medicare claim and what happens next

What Is a Medicare Claim?

Insurance claims are central to reimbursement. They also allow for confirmation that your treatment was covered. We’ll look into what usually happens with claims and what to do if you need to make a Medicare claim.

What Usually Happens?

Federal law mandates healthcare professionals to file Medicare claims for supplies and services in a timely fashion. This is why it is unlikely that you would find yourself in a situation where you would have to file a claim yourself. 

Normally, you go in for your treatment, your doctor goes over your insurance, and then that insurance claim is filed and you pay your bill. And you will see this on your Medicare Summary Notice. This document is delivered via mail once every three months. If you create a Medicare account online, you can view your Medicare Summary Notice at any time. It lists the services you received, along with how much you paid and how much Medicare paid. This allows you to see if your healthcare provider filed the claim. Your Medicare Summary Notice is also helpful because you can detect fraudulent activity if there are services and dates that you don’t recognize.

Why Would I Make a Claim?

This is done when your provider hasn’t filed the claim, and you need to do it on your own accord because there’s no other way to get Medicare reimbursement. In this rare case, this is the only way you can ensure that you get covered.

How Can I Make a Claim?

You cannot file a claim any later than 12 months after the unclaimed service took place. But if you’re within 12 months of that service that wasn’t claimed, you first contact your doctor or another healthcare provider. They can file the claim upon request. 

If you call and the claim isn’t filed, you should ask about the time frame for filing that claim. You may have to file the claim yourself, and you do this by filling out the Patient Request for Medical Payment form (CMS-1490S). With that, you should also include any documents related to the service that your providers failed to claim, the itemized bill, and a detailed letter expressing why you have decided to file the claim.

Send your claim to the address listed on the second page of instructions for the type of claim you’re filing. It is also located on your Medicare Summary Notice.

Need Help Filing a Claim?

If you find yourself in this situation, we can help you sort through this issue and make the process faster. At Turning 65 Solutions, we can help you with this over the phone at (830) 217-6711 and you’ll be able to set the record straight in record time. You can also shoot us an email at ron@t65s.com.

Turning 65 Solutions can help you plan for the future.