I changed how I do my meetings with new clients. I set up their My Medicare login before they leave my office because . . . .
A client called me because he had an unpaid bill. He claimed the insurance company with his Medicare Supplement policy would not pay his hospital bills.
I tend not to react anymore until I have the whole story from all the sources. I said, “Ok, let’s call the insurance company.”
We got a customer service representative on a three-way phone call. The rep said they had received bills from the hospital, but the bills didn’t have Medicare approval and coding. The insurance company requested the hospital send the proper codes, but the hospital didn’t reply.
Medicare Determines What Is Paid
The customer service rep said the insurance company was not refusing to pay; instead, they couldn’t pay until Medicare sent the approval with the proper codes. Then the insurance company would happily pay its portion.
After we got off the phone with the insurance rep, I translated what happened to my client.
How Medicare Billing Works
The hospital is supposed to send the claims to Medicare first, not the insurance company. Medicare determines everything. Medicare already has a schedule of payments for specific procedures. Medicare determines whether the procedure is “medically necessary.” If it is medically necessary, Medicare pays the predetermined fee, which also has a procedural code. You can view the claims through your My Medicare Login.
Medicare Summary Notice (MSN)
Medicare will also send a Medicare Summary Notice (MSN) to you with what was covered, paid, or not paid. You can appeal any claims Medicare refuses to pay at this time. You can also file your own Medicare claims through this portal.
Then Medicare forwards the claims to the insurance company with the necessary coding. The insurance company receives the claim and knows precisely what to pay based on the code. The insurance company sends the money to the provider within 48 hours of receiving the claim from Medicare.
The system is beautifully flawless—usually.
Instead, it sounded like someone at the hospital must have been new, poorly trained, or mistakenly sent the bill to the wrong place.
When the hospital did not receive payment, they did the easy thing and blamed the insurance company and sent the bill to the patient rather than looking at what they did wrong.
Unfortunately, I had to send my client back to the hospital to have them forward the seven-month-old bills to Medicare.
My Medicare Login Is the Solution
Something I am doing now when I meet with clients for the last time is setting up their My Medicare login. Everyone on Medicare has a My Medicare login and an online account with Medicare.
MyMedicare.gov is especially important for clients on Original Medicare (Part A & B only) and a Medicare Supplement/Medigap policy because your bills are sent directly to Medicare, and you can view the transactions on your MyMedicare.gov online account. There is a section called Medicare Summary Notices (MSN). The claims are all there, and how they were handled.
For those on Medicare Advantage (Part C) plans, you can see your bills on your online account with your specific insurance company.
How to Pay Medicare Premium?
On MyMedicare.gov, you can see the claims sent to Medicare, print out your Medicare card, and pay your Medicare Part B premium online if you are NOT getting a Social Security check. It is an excellent tool for everyone on Medicare.
Click on the icon for Pay Part B Premium. You can put in your banking information to pay your premium monthly if you are not receiving Social Security benefits.
Login to Medicare Bills
Everyone should login to their My Medicare account. For the client who thought his Medicare Supplement company was not paying, if he had logged into his My Medicare online account, he could have quickly seen the bills were never sent to Medicare.
Please call us at 402-614-3389 if you need help setting up your My Medicare login for your online account. I want my clients to have the best Medicare insurance experience possible.