Who's on First? Submission Question

B

BSquared18

New Member
Hello,

I am handling my elderly mother's affairs and have run into something new. One provider sent me a bill for medical transport with the comment that they do not submit bills to Medicare or insurers.

I phoned our Plan F insurer, and the rep said the bill needs to first be submitted to Medicare. Yet, the Medicare form 1490S says the filled out form needs to be sent to the insurer.

When I phoned the insurer to get the answer mentioned above, the wait was very long. Last resort, I'll try them again. But does anyone have any info to shed light on this issue?

Bill
 
As far as I know all medicare claims need to be first submitted to Medicare before a Medicare Supplement Insurer will take a look at paying the balance. Medicare automatically submits the bill to the Medicare Supplement Insurer after they have processed their part.
 
Thanks for your quick response, Mack.

The Form 1490S says, "Send completed form to your Medicare carrier." And then it provides an 800 number if help is needed.

I assumed "Medicare carrier" referred to the medigap insurer. Is that assumption incorrect? If not, do I need to phone to find out where to send the form? (I love calling Medicare--not!)

Or do I need a different form?

Bill
 
Sorry i am not familiar with the forms since all my claims have been submitted by the doctor's office. I would call Medicare (I know it isn't fun, but sometimes you have too). Again, I do not think Medigap pays anything until after the claim has been filled with Medicare. Medicare then sends the claim to the Medigap insurer after they pay what they are going to pay. I could be wrong about this, that is must my opinion.
 
Bill,

The 'Medicare Carrier' the form refers to is the processing center for Part B claims in your area. This is usually taken care of by the service provider, but in your case, the transport provider is telling you they do not interface with Medicare so they want you to do the leg work.

Follow this link: www.medicare.gov/Contacts/organization-search-criteria.aspx and choose your State on the right hand side and select "Carrier" The search will give you the address to send your completed 1490S to.

Be sure to include an itemized bill with date and place of service provided or the claim will not be paid. Medicare will pay you directly and you in turn pay the transport provider.
 
You're welcome MAtt. It's not a common issue as you know. Most providers take care of the billing so this is a rare situation.
 
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