QUESTION:
1.
When is the deductible due?
2.
Does Medicare cover inpatient services?
3.
Does Medicare pay for items such as wheelchairs
and walkers?
4.
How do I obtain a Medicare Handbook?
5.
How do I get an itemized bill for a hospital claim?
6.
Who do I report a name change to?
7.
How do I get Part B Medicare coverage?
8.
Who do I report a date of death to?
9.
Do you bill my supplemental insurance?
10.
I'm a Railroad Retiree; why did I get an MSN
from Medicare?
11.
What is a benefit period?
12.
Where does my doctor bill(s) go?
13.
Why was my claim denied?
14.
Does Medicare pay for therapies?
15.
Do you pay for hospice?
16.
Do you pay for cardiac rehab?
17.
I was in an automobile accident. Why won't Medicare
pay for my claim?
18.
My claim was denied because Medicare records
show that the claim was covered by another insurance plan that
is primary to Medicare. This information is incorrect or no
longer current. How do I get my claims paid?
When is the deductible due?
Part B deductible: When you use your Part B Benefits, you are
responsible for paying the first $100 of the charges approved
by Medicare. This is an annual deductible.
Part A deductible: During the first 60 days of an inpatient
hospital stay, Medicare pays all covered costs except for $876.That
is the hospital deductible for 2004, and you are responsible
for paying it. You only pay the deductible once during a benefit
period no matter how many times you go to the hospital. A benefit
period begins the day you are admitted to a hospital and ends
when you have been out of a hospital or skilled nursing facility
for 60 straight days including the day of discharge. It also
ends if you stay in a skilled nursing facility, without receiving
skilled nursing care for 60 straight days.
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Does Medicare cover inpatient services?
In general, Medicare Part A helps pay for covered services
you receive in a hospital or skilled nursing facility or from
a home health agency or hospice program. Hospital, skilled
nursing facilities, home health agencies and hospices are called "providers" under
the Medicare Part A program. Providers submit their claims
directly to Medicare. You cannot submit claims for their services.
The Provider will charge you for any part of the Part A deductible
you have not met and any coinsurance payment you owe. Providers
cannot require you to make a deposit before being admitted
for inpatient care that is or may be covered under Part A of
Medicare. For more information, refer to your Medicare Handbook.
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Does Medicare pay for items such
as wheelchairs and walkers?
In general, Medicare Part B helps pay for durable medical equipment
such as oxygen equipment, wheelchairs, and other medically
necessary equipment that your doctor prescribes for use in
your home. (A hospital or facility that mainly provides skilled
nursing or rehabilitation services cannot be considered your
home.)
To be considered durable medical equipment, the equipment must
be able to withstand repeated use, primarily serve a medical
purpose, and be appropriate for use in your home.
Only your own doctor should prescribe
medical equipment for you.
For more information, refer to your Medicare Handbook.
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How do I obtain a Medicare Handbook?
The Medicare Handbook can be viewed or downloaded from
Medicare publications on the HCFA web-site at
www.Medicare.gov;
or call Medicare at 1-800-MEDICARE (1-800-633-4227) or the
Social Security Office to request a handbook.
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How do I get an itemized bill for a hospital claim?
You may request an itemized statement from the hospital billing
department. This request must be in writing.
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Who do I report a name change to?
The Social Security Administration. The telephone number
for the main office is (800) 772-1213.
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How do I get Part B Medicare coverage?
The Social Security Administration handles Medicare entitlement.
The telephone number for the main office is (800) 772-1213.
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Who do I report a date of death to?
The Social Security Administration. The telephone number
for the main office is (800) 772-1213.
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Do you bill my supplemental insurance?
No. However most facilities will bill your supplemental
insurance. You would need to contact the facility to see if
they bill your supplemental insurance.
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I'm a Railroad Retiree; why did
I get an MSN from Medicare?
If you get Medicare under Railroad Retirement, the doctors
and suppliers must submit your claim to United Health Care
Insurance Co. If you go to the hospital, the claims will come
to Medicare Part A.
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What is a benefit period?
A benefit period begins the day you are admitted to a hospital
and ends when you have been out of a hospital or skilled nursing
facility for 60 straight days, including the day of discharge.
It also ends if you stay in a skilled nursing facility, without
receiving skilled nursing care for 60 straight days.
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Where does my doctor bill(s) go?
All doctors bills are referred to Medicare Part B in
Fargo, North Dakota. Their telephone number is (800) 444-4606.
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Why was my claim denied?
When you receive a denial, you would need to contact your local
contractor, either Blue Cross Blue Shield of Arizona for Medicare
Part A, or Noridian Mutual Insurance Company for Medicare Part
B, to see why your claim was being denied. The phone numbers
are on the Medicare Summary Notice for your convenience.
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Does Medicare pay for therapies?
Yes, physical, occupational and speech therapy when it is medically
necessary and reasonable.
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Do you pay for hospice?
Yes. Please refer to your Medicare Handbook for detailed information.
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Do you pay for cardiac rehab?
Medicare coverage for cardiac rehab is considered reasonable
and necessary only for patients who are referred by their physician
and have (1) a documented diagnosis of acute myocardial infarction
within the preceding 12 months or have had (2) coronary bypass
surgery, and have (3) stable angina pectoris.
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I was in an automobile accident.
Why won't Medicare pay for my claim?
Certain types of insurance are liable for medical expenses
before Medicare. Medicare does not pay for services if payment
can be made by an automobile insurance policy or any other
type of liability insurance (including commercial, premises
and homeowners' insurance). When there is coverage, or the
possibility of coverage, by an automobile and/or other liability
insurer, Medicare does not make payment, except as a secondary
payor. In some instances, Medicare can initially pay a claim,
on the condition of reimbursement, when the litigation case
has settled. You should contact a Medicare office for further
information regarding your rights and obligations under the
Medicare Program.
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My claim was denied because Medicare records show that the
claim was covered by another insurance plan that is primary
to Medicare. This information is incorrect or no longer current.
How do I get my claims paid?
In most instances, the hospital or provider of services has
sufficient information on file, from the admission forms, to
have the Medicare files updated to reflect the correct status
of your other insurance coverage. The provider of services
should resubmit the claim with the correct information to Medicare.
In most instances, the beneficiary would not need to contact
Medicare.
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