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How To Protect Yourself When Dealing With Your Medicare Insurance Company
Author David Schneider | May 23,2007
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Because of their size, insurance programs such as Medicare may make mistakes. Sometimes there just may be a misunderstanding about what is covered or not covered. It is important for you to know the procedures that can be followed when such a situation occurs. Here are some of the steps you can take to protect yourself when dealing with your Medicare insurance company.
Know The Guidebook
One of the most important ways to protect yourself is by knowing the guidebook for your particular Medicare plan. You should read it through in order to understand its provisions. Certain procedures that are not covered will be listed, and the drugs that are not covered will also be listed. In order for any of these to be covered, you will need to get permission from Medicare by having your doctor contact Medicare and prove the necessity of the procedure or medication.
Get Detailed Billing
As a member of the Medicare original plan you will get a statement called a Medicare Summary Notice (MSN). If, after you find that Medicare has not paid for some medical procedure that you received and thought they should have paid for, then you should do the following.
1. Make sure your provider billed Medicare. It is possible that he or she never sent the bill for the services.
2. Get documentation. The provider should be able to give you a copy of the itemized bill, which should clearly list everything on it that is billable to Medicare. If so, get any documentation you can from the doctor, or doctor's office. If the documentation indicates a bill was never sent to Medicare, get them to send a bill.
3. Send copies to Medicare. On a copy of your MSN, you want to circle the debated item, and write your reason next to it as to why you think it should have been paid. Also, include your phone number on that page so they can ask further questions.
It is important that you keep an eye on your MSN and know what is paid for and what is not. While you do have rights to appeal, Medicare wants you to do them within 120 days after you get your MSN.
In order to help you know when a medical procedure may not be covered, your doctor should give you an Advance Beneficiary Notice. This notification lets you know that a procedure you need (or want) will most likely not be covered by Medicare. You will then be required to sign a statement - if you still want the procedure, indicating that you are aware that you will most likely have to pay for it yourself.
Other Plans
If you are not in the original Medicare plan, then you need to contact your network provider and work through them. The procedure is different, but they must initiate it.
Drug Plans
Whenever you have a dispute about whether or not your drug plan should cover a particular medicine, you should contact your Medicare drug provider. Two reasons when you might want to do this are if you were told they will not fill a certain prescription, or if you are charged more than the plan indicates. A procedure will need to be followed before you are given permission to get a prescription not on the list. First, your doctor must try a similar, accepted drug. Then, if that fails to have the desired effects, the doctor can ask for a new medication for you to be approved.
Exceptions
Sometimes a situation comes up with an individual's health care where an unapproved procedure becomes medically necessary. In this case, and if your doctor agrees, you can ask them to write Medicare and explain why they think it is medically necessary. Medicare promises to get a response back to you within 72 hours from the time they get it, as to whether it will be paid for by Medicare or not.
This system has worked for many to be able to voice their opinions and problems to the Medicare system and be heard. It is not a system without a heart. If you are getting ready to turn 65, then you need to start looking into what Medicare can do for you. Start at QuoteMatch.com and get several excellent quotes from qualified Medicare insurance brokers. |
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