Understanding How Medicare Claim Works

Learning About Medicare Claim And How Long It Takes To Process Before The Claim Approves

What Is Medicare Claim

A Medicare claim is a type of payout that your insurance provider or where your insurer will pay for your medical care. Claims happen when after you see a doctor or you are treated in a hospital.

When you enrolled in a Medicare Advantage or Part D, your provider will process the claims on Medicare’s behalf.

Who File Medicare Claims

Medicare Part A and B are submitted directly to Medicare by your insurer. It takes approximately 30 days to process each claim. Medicare Part A claims directly to the facility or agency that provides you the care.

You’re the one responsible for the deductibles, copayments, and non-covered services. While Medicare Part B claims are submitted either to your provider or by yourself. But the claims will be determined by the assignments:

• If the providers agree to accept the assignment, meaning he accepts the Medicare’s approved amount as full reimbursement. Medicare will the Part B claims directly to him or her for 80% approved amount. And the remaining 20% will be shoulder by you, this will be your co-insurance.
• If the provider does not accept the assignment, he/she is required to send in your claims to Medicare, which then pays the Part B claim directly to you. And you will shoulder the pay 

Beneficiaries can submit their own claims for certain services when the insurer won’t file a claim. However, you cannot file a claim with the Original Medicare for diabetic test strips, Part B drugs, or medical equipment paid under DMEPOS Competitive Bidding Program. Your pharmacy or medical supplier must bill Medicare for these items.

Where Do I File Claim

Original Medicare has participating and non-participating providers. Participating providers accept Medicare reimbursement plus your coinsurance as full payment. And they agreed to always bill Medicare once you need to receive care. On the other hand, non-participating providers can charge you up to 115% of Medicare’s rate and don’t need to file claims with Medicare. This means that you have to submit your own healthcare claim if you choose to see a non-participating provider.

How Long Does The Claim Need To File

Original Medicare claims must submit within 12 months of when you received care. Medicare Advantage plan has different time limits, the time limits for advantage plan is shorter than Original Medicare. The best way to find out the time limits for your Medicare Advantage is to ask your insurance provider.

If you have any questions about your Medicare status, claims, and eligibility you can reach Chris Antrim as he knows when it comes to Insurance and Medicare. When it comes to insurance and Medicare it is always better to ask your agent if you don’t understand anything. Remember that you are the one using the benefits not them.

Thank You For Your Time Reading!

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