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medicare what can i claim

My doctor or provider will not file a Medicare Claim. What can I do?

An unfortunately common problem facing a person with Medicare, is what to do if their doctor or provider refuses to submit their bill to Medicare. Medicare claims are required to be submitted within one (1) year. So this is important.

There are several options, depending on your situation. If Medicare is the primary insurance for treatment, do the following:

1. Contact your doctor or provider and request they file a claim with Medicare. Request their reasons for not filing. This should be the first thing you do.

2. Contact Medicare (1-800-MEDICARE) and submit a Patient Request for Medical Payment form. You can also request specific filing information from Medicare regarding claim dates.

If Medicare is considered a secondary insurance (for example, if your injuries stemmed from an accident involving liability or no fault insurance), then your options are more limited:

1. Contact your doctor or

provider and request they file a claim with Medicare. Request in writing their reasons for not filing.

2. Contact the Coordination of Benefits Contractor (1-800-999-1118) to report the underlying accident or cause of the secondary determination. Any conditional payments will go through the CoBC, and they will need a record of the incident resulting in your medical treatment.

3. Demand, in writing, your doctor or provider submit the claim to Medicare. Offer to provide any background information your doctor or provider may need to complete a claim. This may be futile, since doctors and providers have the option of hanging onto medical liens rather than submitting bills to Medicare. However, you will have documentation demonstrating your attempts to have the bills paid through Medicare, should the provider attempt to collect on the bills later.

These are some straightforward actions you can take if a doctor or provider refuses to submit bills to Medicare. Hopefully you will not need to utilize them.

Category: Insurance

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