Organizing your medical bills
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If you are in a Medicare Advantage plan (i.e. Medicare HMO)
If you belong to a Medicare Advantage (MA) plan, you generally won't receive statements from Medicare or have to file claims. Medicare Advantage plans process the paperwork internally. There may be some instances, however, when you receive a statement from Medicare or a bill from a provider. If you have questions or think this is in error, contact your plan's customer service department or call the Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222 for assistance.
If you have Original fee-for-service Medicare with or without supplemental insurance (Medigap) or a retiree plan
Filing your Medicare claims and your supplemental insurance (Medigap) company or retiree plan will be much easier if you organize your medical bills and records. It will also make it easier for you to file your annual income tax return. These steps can help you get your medical files in order.
- Sort your bills -Make a separate file folder for each provider (doctor, hospital, lab, ambulance service, suppliers, etc.). Arrange each provider's bills by date with the most recent one on top.
- Sort your Explanation of Medicare Benefits (EOMB) or Medicare Summary Notice (MSN) forms -Medicare sends you an Explanation of Medicare Benefits (EOMB) or Medicare Summary Notice (MSN) form for your claims. The form shows the amount of the bill(s), whether it was assigned, how much was approved and paid, and how much is still owed. Match each EOMB or MSN with the corresponding medical bill(s), putting the EOMB or MSN into the folders for each provider. Some MSNs list claims from more than one provider — you should make copies of these so you can put one in each provider's folder. Medicare sends out your EOMB or MSN every 90 days. Note: this is a new timeframe; Medicare used to send out MSNs each month. If you don't have an EOMB or MSN for each all your bills, it probably means that Medicare hasn't finished processing the claim and/or it’s too early in the quarter for you to receive your form.
- Sort your supplemental insurance claims –If you can, wait until you receive your quarterly EOMB or MSN to determine whether to submit a claim to your Medicare supplemental insurance. Sort your claims to your supplemental insurance by provider, match them to the corresponding provider bills and EOMB or MSN, and put them in the same folders. For many Medicare supplemental companies, the Medicare carrier will automatically forward your claims. Ask your company if you have this option. If not, submit the provider's bill, along with the Medicare EOMB or MSN, to your Medicare supplemental insurance company. Keep a copy of what you sent, with the date you sent it, in your folder for each provider.
- Fill out your Health Insurance Claims Record - Fill out your Health Insurance Claims Record so you have a complete summary of all your bills and payments. The form will guide you in figuring out how much, if any, you are personally responsible for paying each provider. Keep your Claims Record up to date by revising it every time you get new information about your medical financial status. If any information is missing, call your provider, your insurer, or Medicare to get it. See instructions for completing your Health Insurance Claims Record. You can also download the Claims Record form (PDF) (fact sheet G-003).
Billing tips if you have Original fee-for-service Medicare
How to make sure you're billed correctly
- Ask your doctor if he or she accepts Medicare assignment. If so, it means your doctor will accept what Medicare approves. You will pay the 20% co-insurance and any remaining deductible for the year.
- You may want to choose doctors who always accept Medicare assignment so you are billed the least possible amounts. Some doctors will accept assignment for one patient and not another; it pays to ask. Some doctors' offices may say they don't accept Medicare at all. They may mean that they don't take assignment, but they do take Medicare patients. In a few cases, a doctor's office may no longer be accepting any new Medicare patients, but it still provides care to existing Medicare patients.
- If your provider accepts Medicare assignment, he or she should charge no more than the Medicare-approved amounts. You pay the doctor no more than your 20% co-insurance and any portion of your annual deductible that hasn't been met.
- Medicare limits the amount that a doctor who does not take assignment may charge a Medicare beneficiary. This is called a "charge limit" or "limiting charge." If your doctor does not charge Medicare-approved amounts, by law he or she is limited to charging no more than 15% over and above Medicare's approved amount. These limits also apply to independent physical and speech therapists.
- Your health care provider is required to bill Medicare for services that are covered by Medicare. Once Medicare has processed the claim, you will receive your quarterly Explanation of Medicare Benefits (EOMB) or Medicare Summary Notice (MSN) that details what you are expected to pay.
- Check your Explanation of Medicare Benefits (EOMB) or Medicare Summary Notice (MSN) to make sure that you actually received all the services that were billed to Medicare. If there's a charge on the notice that's incorrect, call your doctor's office and ask for clarification. If you still are not satisfied, contact Medicare directly (at the number listed on your statement) or call your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222 for help.
- Some doctors may ask you to pay them directly because they do not accept assignment. In this case, Medicare will send the check to you. If you have a Medigap policy, that check will also come to you. Make sure that amounts on the doctor's bill match both the amounts on the Medicare Summary Notice and the amounts paid by your Medigap policy. If you have any questions about the payment of your bill, contact HICAP for help.
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Page updated October 24, 2008
