Questioning your Medicare Summary Notice
Posted on July 3, 2011 by bob in Medicare
Dear Marci,
Original Medicare won’t pay for a health care service I received. What can I do? — Xiang
Dear Xiang,
If Original Medicare will not pay for care you received, you will find this out when you receive your Medicare Summary Notice (MSN). If you think the care you received is medically necessary, you should not take no for an answer.
1. Find out if it is possible that there was a billing mistake. Sometimes providers accidentally use the wrong service codes when filling out Medicare paperwork, and this can result in Medicare denials. A denial can sometimes be easily resolved by asking your doctor to double-check that your claim was submitted with the correct codes. If the wrong code was used, ask your doctor to resubmit the claim with the correct code.
2. If the provider believes that the claim was correctly coded or is unwilling to refile the claim, your next step is to appeal. The MSN will have instructions for how to appeal. Follow these instructions and then mail the signed original to Medicare at the address on the MSN. Make sure you request your appeal within 120 days of receiving the MSN. If possible, get a letter from your health care provider saying that you needed the service and why. Send this with your MSN.
Keep photocopies and records of all communication with Medicare, whether written or oral, concerning your denial. Send your appeal certified mail or delivery confirmation.
Note: You cannot appeal to Medicare to cover services or items that are never covered, such as hearing aids.
Marci’s Medicare Answers is a service of the Medicare Rights Center, www.medicarerights.org, 800-333-4114. For more information visit www.medicareinteractive.org.
