Medicare is a program that is paid for by the federal government and is designed to provide financial assistance to seniors and other persons with disabilities.
With Medicare, you can receive medical insurance, prescription drug coverage, and other vital services. But, if you need to file a claim, you might find yourself wondering how to go about it.
This article will give you all the details you need if you need to file a claim.
You Should Rarely Have to File a Claim
Doctors and hospitals are normally responsible for filing insurance claims, including Medicare claims. You can check your Medicare Summary Notice or check your online Medicare account to make sure the claims are being filed at the appropriate times. You can log in to your account at any time, but you’ll receive your Medicare Summary Notice every three months in the mail.
Why You May Need to File a Claim
Some providers claim that they “don’t accept assignment”- meaning that they do not accept or participate in Medicare, at least not directly. This is because Medicare generally provides 80% of the reimbursement that private insurance does.
To get around this, some doctors don’t participate in the program directly and make their patients pay upfront and seek reimbursement from Medicare themselves. This is so they can charge up to 15% above what Medicare will normally pay (the 15% limit set by law). Unfortunately for the patient, since Medicare will not reimburse the extra amount, you will be responsible for the extra charges and having to file the paperwork.
For these reasons, if a doctor refuses to participate in Medicare and makes you file the paperwork, you should probably get another doctor. However, if you need to file a claim with Medicare, the next section will help you do just that.
How to File a Claim
When you need to file a claim with Medicare, your best option is to file your claim directly with Medicare.
To do this, you can go to the website medicare.gov and fill out any forms you may need, or you can call 1-800-MEDICARE.
According to Medicare.gov, you will need the following information:
- The claim form (Patient Request for Medical Payment form (CMS-1490S) [PDF, 52KB])
- An itemized bill from your healthcare provider, doctor, or supplier
- A letter explaining your reason for submitting the claim
- Any supporting documents related to your claim
Once you have done so, you will receive an acknowledgment of your claim.
For Help With Medicare Claims, You Need An Agent
Medicare is a complicated program, and it can be difficult to navigate the exact costs of multiple plans. You need an agent who keeps in touch, knows what they are doing, and helps you get what you need. Call the Medicare With Jake team and get the plan you deserve today!
