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Summary

Medicare requires your doctor or other health care provider to file a claim directly with Medicare.

It's important to keep track of your medical bills to make sure all charges are reviewed and proper payment is made, especially if you have Medicare and another health insurance plan.By keeping track of your Medicare Bills:

  • You will have a fix on how much your out-of-pocket costs are for budgeting and tax deductions purposes.
  • You will save money by making sure you're not being overcharged for services.
  • You will avoid problems with medical creditors, who are often persistent and quick to report late payments to a credit bureau.

If you have continuing access to the internet, Medicare posts claims and their status on www.MyMedicare.gov offsite link. Even then, mistakes can happen so it is a good idea to keep your own records. Click on "sign up" (you will need your Medicare i.d. number to register.)

If you don't have continuing access to the internet, or want to be smart consumer, you can set up your own, preferably easy-to-use, system. For an example of an easy to use system, click here.  For tips about using the system, click here.

If you'd prefer, ask a friend or family member to help keep track of your medical bills. You can also hire a claims professional. See Claims: Finding Professional Help.

NOTE: If you have Medicare and another health insurance plan, click here.

How To Use The System

You can use this system step-by-step as follows:

After your visit

  • If your provider will give you a bill at the end of your visit: Review it right away and ask any questions on the spot.
  • If your provider is going to mail you a bill: Note the specifics of the visit in your file, including any lab work or other procedures performed.

When you receive your bill

  • Check it against your notes for accuracy.
  • If your bill is correct: Put it in your "Unpaid Bills" folder.
  • If your bill does not seem correct: Contact your provider's office for an explanation and/or corrected bill. Place the bill into the Questionable Bills folder until you receive a corrected bill. Make sure the provider sends a corrected bill to Medicare. Note this on the bill so you know you'll be receiving two Medicare Summary Notices (MSNs) - one for the incorrect bill and one for the corrected one.

When you receive a Medicare Summary Notice

Place it in your "MSN" folder until you can review it.

Review the Medicare Summary Notices in your MSN folder.

To review a MSN:

  • Find the matching bill in your unpaid bills folder. Use the date of service, provider information, and dollar amounts to make sure you're checking the right bill.
  • Make sure the procedures and amounts billed on the MSN match those on the bill.
  • Check to see that the entire bill was processed. If it wasn't, attach the MSN to the bill and file it in the unpaid bills file until you get an MSN addressing the remainder of the charges.
  • Check to see if Medicare allowed the full charge or not. If not, you might want to contact Medicare.
  • Verify that the annual deductible was only taken once.
  • Verify that the right co-insurance percentage was applied.

If everything in the Medicare Summary Notice is correct

Staple the Medicare Summary Notice to the bill and file it in your Completed Claims folder. If there is a portion remaining for which you are responsible, note that. You don't need to pay this money until the doctor bills you for it, or you arrive at an agreement with the doctor's billing clerk on how much you owe.

If your Medicare Summary Notice is incorrect

Contact Medicare for an explanation. File the bill and Medicare Summary Notice together in the Questionable Medicare Summary Notices folder until you are able to resolve the error(s), and you receive a corrected Medicare Summary Notice..

For help about how to speak with Medicare, see: Talking To Your Insurance Company.

Periodically review your Unpaid Bills file.

Set a rotating alert in your diary to remind you to review your Unpaid Bills file every few weeks.

If a bill has been in the file for more than four weeks without receiving a matching MSN, call Medicare to check on the claim's status.

You may want to wait until you have three or four claims assembled with questions before calling Medicare - but don't wait more than 30 days from receipt of the MSN. A longer delay may provoke a "if he/she doesn't care, why should I?" attitude which may hamper your getting what you're entitled to.

An Easy Tracking System

There are many ways to set up a medical bill paying system. Just make sure it's easy for you to use and simple enough that others could step in and take over for you if necessary. With a good system, you'll always know the status of every claim from the day you incur a charge to the day you or your doctor receives payment.

To give you an idea of a simple medical bill paying system, here's an illustration using five folders.

UNPAID BILLS: Consider a separate folder for each provider.

MEDICARE SUMMARY NOTICE (MSNs):  Medicare's written response to your claims.

QUESTIONABLE BILLS:  Bills that you need to check with your provider.

QUESTIONABLE MEDICARE SUMMARY NOTICES:  Statements you need to check with Medicare.

COMPLETED CLAIMS:  Fully paid claims, including a copy of the check or receipt of your cash payment, if any.

For this system to work, you'll need to get a copy of each and every medical bill, including bills submitted directly to Medicare by your provider or providers.

You may encounter some resistance from your provider to giving you copies of the bills because most providers are no longer used to sending bills to patients. They may also be aware that Medicare posts bills on www.MyMedicare.gov offsite link.

If you do encounter resistance, consider explaining to the billing person at your doctor's office that:

  • You do not have access to the internet on a regular basis
  • You want to pay what you owe, but that without a copy of the itemized bill to compare to Medicare's Medicare Summary Notice, you have no way of knowing the correct amount.

Once your provider's office gets in the habit of providing you with a copy of their bills, you should hopefully encounter less resistance.

If You Have Medicare And Another Health Insurance Plan

If you are covered by Medicare and another health plan:

  • Read Medicare - Coordination of Benefits to understand how the coverages relate to each other, and which plan is Primary and which is Secondary.
  • Become familiar with, and start keeping, the forms you will receive from the insurance company and the Medicare payers:
    • Explanation of Benefits (EOB) is the statement you receive from the insurance company every time a claim is processed. It shows what the insurance company paid (or didn't pay) along with of brief explanation of how the decision was arrived at.
    • Medicare Summary Notice (MSN) is the statement the Medicare claims payer sends you when a claim is processed. It is very similar to an insurance company's Explanation of Benefits (EOB.)
  • Create a set of folders as described above. Then create two more folders:
    • One for bills that have been processed by the primary plan but not the secondary plan, with the primary plan's EOB or MSN.
    • One for the secondary plan's EOBs or MSNs until you can review them with the bill and primary plan's EOB/MSN to make sure they were processed correctly.
    • When both plans have processed the bill correctly, bind the bill, EOB, and MSN together and put them in your Completed Claims folder. If they're not processed correctly, as noted above, they go into the folder for questionable EOBS and bills.

Keep in mind that:

  • The secondary carrier will not process the claim until the primary carrier has completed processing it.
  • In addition to the itemized bill, the secondary carrier will require a copy of the primary carrier's MSN. Using the Five Folder System described above, you will be able to readily supply your secondary carrier with all of the needed information. You'll be able to keep track of what is happening with each company in your "Processed" and "Not Processed" folders.

NOTE: This system will work whether the second plan is individual or group and whether Medicare is primary or secondary.

Tracking Claims on the Net

Medicare makes claims information available via the Internet.

To find the information:

  • Go to www.Medicare.gov offsite link
  • Look for the "MyMedicare.gov" box in the upper left hand corner
  • Click on "sign up" (have your Medicare card handy: you'll need your i.d. number)