If you head on to Medicare’s website, you’ll notice how extensive their help articles are. That’s because Medicare can really be complicated especially to an aging brain like me. It is really easy to get lost there and just navigating my way through the website got me dizzy! Aside from that, you will have to read articles twice before you understand what the article is trying to say. I’m quite a reader, yes, but procedures bore me to death and sometimes, when it gets really boring, I tend to speed-read to a point of merely browsing thus missing important nuggets of knowledge hidden beneath the words. I’m bad. I know.
First off, it is only in very rare instances that you are required to file a claim. The supplier or physician should be the one to file a Medicare claim whether they accept an assignment or not. If and when you need to file a claim, do note that you have to file within a year from the day you acquired the service. That is the general rule.
However, if you are buying medications and would want to use Medicare to cover your expenses, you need to know first if the pharmacy is enrolled in the Medicare program. If so, then you don’t have to do anything as they will be the one to file the claim, not you. If not, then you have no choice but to pay the bill or look for a pharmacy that is enrolled in the program. Medicare will not pay those pharmacies that are not enrolled in their program. No ifs, no buts for pharmacies.
On the other hand, doctors and other health care providers such as nursing facilities and hospices may or may not accept assignment but still file for a Medicare claim. This means, you, as the patient, can still benefit from Medicare even if the doctor is not accepting assignment. Whether they accept an assignment or not, it is their offices that should file a Medicare claim, the only difference would be your out-of-pocket cost since you will be shouldering most of the bill. Aside from that, your health care provider may even charge you up to 15% of the Medicare-approved total. Also take note that you will pay the full amount during these instances and Medicare will only reimburse you their share by sending you a check after an approved claim. It is important that you keep an eye on that check as you may need to do a followup on your provider if they are not filing a claim. This is the only way Medicare will pay you—that is, if they approved a claim made on your name.
The only time you will need to personally file a claim is when your provider is not doing it despite repeated calls and follow-ups and you are already nearing your time limit. If this is the case, then you must call Medicare office for assistance. You will be asked to complete several forms and submit when done.
