How to file a medical claim with Medicare

Dear Toni: I went to see my primary care doctor, and his office manager informed me that they are no longer accepting Medicare. I recently enrolled in Medicare and will have to pay the complete bill upfront and be reimbursed by Medicare. His office is a small one, and he will be retiring soon, so I need to find a new doctor. Can you please tell me what I need to do to submit the bill to be reimbursed? — Cybil, Louisville, Kentucky

Dear Cybil: The Toni Says office has heard from a few clients whose primary care or other medical providers are retiring. The office paperwork is overwhelming.

These offices do not accept Medicare and will not bill it for you. They want you to submit the claim and wait to be reimbursed.

I have not heard of this type of problem with larger medical offices, especially those that are part of a hospital system.

My advice to clients who are new to Medicare is to search for medical providers who are accepting Medicare, especially when a serious health issue is involved.

Here are some more tips:

■ Before you set the appointment for your medical visit, ask the doctor’s office if they are still accepting Medicare. More specifically, if this is a new doctor’s office, ask if they are accepting “new Medicare patients” and whether they will bill Medicare directly.

■ If the doctor’s office says “no,” you will need to make a decision:

Do you want to pay out of pocket and be reimbursed only what Medicare pays? Remember, doctors know they are not paid their asking rates. Medicare is not the only entity that discounts the doctor’s bills. Group and individual health insurance plans with network providers also discount the doctor’s bills.

Or do you want to look for a doctor or specialist who will accept Medicare assignment and bill Medicare directly? Again, you should verify that the office is accepting new Medicare patients. Ask your primary care doctor to recommend more than one doctor or provider for your specific medical situation.

■ If your doctor does not accept Medicare, it is not hard to file a claim. You may have to pay the complete bill and submit the claim to Medicare. Make a copy of your bill to send to Medicare, with any information regarding your medical claim.

■ Visit Medicare.gov and search for “filing a claim.” The information provided will explain how to submit a claim by downloading form CMS-1490S, Patient Request for Medical Payment. The form has instructions to include an itemized bill and supporting documents and where you need to send everything.

If you need help filing a claim, call Medicare at 800-633-4227.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.