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Section 1: The Original Medicare Plan (continued)   |
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Q: How are my bills (claims) paid in the Original Medicare Plan? A: When you receive services covered by the Original Medicare Plan, your provider sends the bill (claim) to a private insurance company that contracts with Medicare. These companies are called the Fiscal Intermediary (for Part A services) or the Medicare Carrier (for Part B services). After they process the claim, you receive a Medicare Benefits Notice (for Part A services) or a Medicare Summary Notice (MSN), or an Explanation of Medicare Benefits (EOMB) for Part B services. You have a right to request an itemized statement from the provider of the service. You must receive it within 30 days of your request. Please check the notice to be sure you were not billed for services, medical supplies, or equipment that you did not receive. If you have any questions about bills or services listed on the notice, call the Fiscal Intermediary or Medicare Carrier (the name and phone number are on the notice). If you disagree with a claims decision, you have the right to file an appeal. The notices tell you how to file an appeal. Q: How do I appeal a Medicare payment or coverage decision under the Original Medicare Plan? A: If you are dissatisfied, you have a right to appeal any decision concerning your Medicare-covered services in the Original Medicare Plan. You can file an appeal if you believe Medicare did not pay enough for services or should have paid for health care services you received. Your appeal rights are written on the back of the Medicare Summary Notice or Explanation of Medicare Benefits that is mailed to you. Q: What can I do if I think I’m being discharged from the hospital too soon? A: If you believe you are being discharged too soon from a hospital, you have a right to immediate review by the Peer Review Organization* (PRO). You can stay in the hospital at no charge and cannot be discharged before the PRO makes a decision. * You can find phone numbers for your area in your copy of Medicare & You or on the Internet at www.medicare.gov under Important Contacts. Q: Are there rules that protect me in a Skilled Nursing Facility (SNF)? A: Every Medicare Skilled Nursing Facility (SNF) must meet quality standards. They can’t require you to pay a deposit or other payment to be admitted to the facility unless it is clear that Medicare does not cover the cost of services. If the SNF staff decides you don’t need the level of skilled care covered by Medicare, you must be told immediately. If you disagree with this decision, the SNF must request an official Medicare decision on coverage. The SNF can’t require you to pay a deposit for services that Medicare may not cover until Medicare gives its decision. You must pay for any coinsurance while your claim is being processed, and for services not covered by Medicare. If you have questions about SNF care, call your Fiscal Intermediary*. * You can find phone numbers for your area in your copy of Medicare & You or on the Internet at www.medicare.gov under Important Contacts. |
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