Every three months, those with original Medicare receive a claims statement called a Medicare Summary Notice.
As Medicare.gov explains, this notification describes all the services or supplies that providers or suppliers attributed to Medicare during the preceding three months. The document shows how much of each payment Medicare covered and the maximum amount the recipient could owe the provider.
Using Medicare Summary Notices
As the Medicare Summary Notice lays out how much Medicare covers and how much is left for the individual to cover, it is a helpful tool. Review your Medicare Summary Notices regularly. Going over the information allows you to catch discrepancies between your records and the claims statement, which is why keeping records of your care is essential.
Medicare recommends keeping the following in mind when reading over your notices:
- Compare your receipts and bills to the care listed on the statement, ensuring you obtained all the listed care. If Medicare bills you for something you did not receive, you can dispute the incorrect charges.
- For bills already paid, verify you submitted the correct amount for your medical treatments.
- Those with additional insurance should note whether their independent insurance takes care of services or supplies Medicare declined to cover.
Difficulties With Claims Statements
Beneficiaries might not get a Medicare Summary Notice in the mail for several reasons:
- People enrolled in traditional Medicare will only receive a Medicare Summary Notice by post if they obtained services or supplies in the past three months. Medicare does not send notices to people without recent care.
- Some might have received medical assistance in the past three months, but have not seen the notice in their mail. They might not have gotten the claims statement because they still need to update their address following a move.
Keeping your address current ensures Medicare mails your notice to the correct location. Most beneficiaries can change their addresses by informing Social Security. However, those with U.S. Railroad Retirement Board Benefits should update their addresses by contacting their local United States Railroad Retirement Board field office.
Responding When Medicare Denies Coverage
In some cases, claims statements inform beneficiaries that Medicare does not cover treatment. If Medicare denies you coverage, you can take steps to request coverage.
First, it is a good idea to call your provider’s office to verify that they gave Medicare the correct information. Sometimes, doctors and other health care professionals make mistakes, causing Medicare to reject coverage. Fortunately, your provider can resubmit your claim with accurate information, which may result in Medicare extending coverage to your care.
Should your notice state that Medicare will not cover care that you believe it should include, you can ask Medicare to pay for it by filing an appeal. The final page of the Medicare Summary Notice contains instructions on asking Medicare to reconsider its coverage decision.
Instead of mailing notices, Medicare allows beneficiaries to choose to view information about their care and coverage online. So, you can see monthly statements once you set up an account with Medicare via Medicare.gov, rather than waiting to review information every three months.
It is important to note that signing up for online notices means that Medicare will no longer mail them to you. Consider whether you prefer online or mailed notifications.
Assistance With Medicare Summary Notices
Those having difficulty understanding, disputing, or obtaining their Medicare Summary Notices can reach out to an elder law attorney who has experience working with Medicare for assistance. An attorney can explain the claims statement and provide representation for an appeal.