Reviewing your Medicare Summary Notice (MSN) is important, but understanding it can be a challenge. That's why AARP has created two easy-to-use Medicare Summary Notice "decoders": one for Part B (below), the other for Part A. Follow the decoder instructions at right, or access a printable version of our MSN's pop-up text.
1. Click on a number to open its pop-up window.
2. When done reading, click on another number.
3. To hide a window, tap its "Close" button.
Medicare Summary Notice1
For Part B (Medical Insurance)
Notice for Beneficiary Name
- Medicare Number
- dotted line
- Date Notice Printed
- December 6, 20135
- dotted line
- Date Claim Processed
- November 2, 2013
Your Deductible Status8 Your deductible is what you must pay for most health services before Medicare begins to pay.
Part B Deductible: You have now met $85 of your $147 deductible for 2013.
Be Informed! Register at www.MyMedicare.gov to view your original Medicare claims, to track your preventive services and print an "On the Go" report to share with your provider. Visit the website to sign up and access your personal Medicare information.
Your Cost for This Claim
See claim. Look for NO in the "Services Approved?" column. See the section for "How to handle a
- Total You May Be Billed7
Provider for This Claim9 October 18, 2013
Susan Jones, MD
The codes and dollar amounts shown on this sample Medicare Summary Notice are for demonstration purposes only.
Dr. Susan Jones, M.D., 555-555-1234
Physical Therapy Center, Street Address, City, State, Zip Code11
|Service Provided & Billing Code12||14
|Therapeutic exercise to develop strength,
endurance, range of motion and flexibility; each 15 minutes (97110)13
|Total for claim #11-10366-697-75020||$45.00||$28.54||$22.83||$5.71|
Notes for Claim Above21 Your claim was sent to your Medicare supplement insurance (Medigap policy). Send any questions regarding your benefits to them.
The codes and dollar amounts shown on this sample Medicare Summary Notice are for demonstration purposes only.
The dropdowns below include information sections from Medicare that you may find on your Medicare Summary Notice.
Your claim for Part B (Medical Insurance)
Your Claim for Part B (Medical Insurance)
Part B Medical Insurance helps pay for doctors' services, diagnostic tests, ambulance services, and other health care services.
Definitions of Columns 14 - 18
Service Approved?: This column tells you if Medicare covered the home health service.
Amount Provider Charged: This is your provider's fee for this service.
Medicare-Approved Amount: This is the amount a provider can be paid for a Medicare service. It may be less than the actual amount the provider charged.Your provider has agreed to accept this amount as full payment for covered services. Medicare usually pays 80% of the Medicare-approved amount.Amount Medicare Paid: This is the amount Medicare paid the provider. This is usually 80% of the Medicare-approved amount.
Maximum You May Be Billed: This is the total amount the provider is allowed to bill you. This is usually $0. For durable medical equipment, it can include 20% of the Medicare-approved amount. If you have Medicare supplement insurance (Medigap policy) or other insurance, it may pay all or part of this amount.
Making the most of your Medicare
Making the Most of Your Medicare
How to Check This Notice
Do you recognize the name of the doctor or provider? Check the dates. Did you have an appointment that day?
Did you get the services listed? Do they match those listed on your receipts and bills?
If you already paid the bill, did you pay the right amount? Check the maximum you may be billed. See if the claim was sent to your Medicare supplement insurance (Medigap) plan or other insurer. That plan may pay your share.
How to Report Fraud22
If you think a provider or a business is involved in fraud, call us at 1-800-MEDICARE (1-800-633-4227).
Some examples of fraud include offers for free medical services, or billing you for Medicare services you didn't get. If we determine that your tip led to uncovering fraud, you may qualify for a reward.
How to Get Help with Your Questions
Ask us for "doctor services." Your customer-service code is 05535.
TTY 1-877-486-2048 (for hearing impaired)
Contact your State Health Insurance Program (SHIP) for free, local health insurance counseling. Call 1-555-555-5555.
Medicare Preventive Services
Medicare covers many free or low-cost exams and screening to help you stay healthy. For more information about preventive services:
- Talk to your doctor.
- Look at your "Medicare & You" handbook for a complete list.
- Visit www.mymedicare.gov for a personalized list.
Your Messages from Medicare
Get a pneumococcal shot. You may only need it once in a lifetime. Contact your health care provider about getting this shot. You may pay nothing if your health care provider accepts Medicare assignment.
To report a change of address, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
How to handle a denied claim or file an appeal
Get More Details
If a claim was denied, call or write the provider and ask for an itemized statement for any claim. Make sure they sent the right information. If they didn't, ask the provider to contact our claims office to correct the error. You can ask the provider for an itemized statement for any service or claim.
Call 1-800-MEDICARE (1-800-633-4227) for more information about a coverage or payment decision on this notice, including laws or policies used to make the decision.
If You Disagree with a Coverage Decision, Payment Decision, or Payment Amount on this Notice, You Can Appeal
Appeals must be filed in writing. Use the form to the right. Our claims office must receive your appeal within 120 days from the date you receive your official Medicare Summary Notice listing this claim.
If You Need Help Filing Your Appeal
Contact us: Call 1-800-MEDICARE or your State Health Insurance Program for help before you file your written appeal, including how to appoint a representative.
Call your provider: Ask your provider for any information that may help you.
Ask a friend to help: You can appoint someone, such as a family member or friend, to be your representative in the appeals process.
Find Out More About Appeals
For more information about appeals, read your "Medicare & You" handbook or visit us online at www.medicare.gov/appeals.
1. Medicare Summary Notice
Medicare sends out statements like this example quarterly. If you didn't use any medical services in a particular three-month period, a statement won't be sent. Your Medicare Summary Notice shows all services billed to your Medicare Part B account for doctors' services, tests, outpatient care, home health services, durable medical equipment, preventive services and other medical services.
2. Name and Address
If the name or address listed here is not correct, visit your local Social Security Administration office or call 1-800-772-1213 (TTY 1-800-325-0778 for the deaf or hard of hearing), weekdays from 7 a.m. to 7 p.m. You can also make the corrections online at SSA.gov.
3. This Is Not a Bill
Yes, that's right! Your Medicare Summary Notice is not a bill. It is a statement you should review for accuracy and keep for your personal records.
Very important: Never send a health care provider payment for charges listed on a Medicare Summary Notice until you've received a bill for the service directly from the provider. If you have already paid the provider, check to make sure that what you paid matches the amounts on your Medicare Summary Notice. If you paid more than needed, contact the provider's billing office to request a refund.
4. Your Medicare Number
This is the number on your Medicare card. Protect it just as you would a credit card, bank account or Social Security number because, as you may have noticed, it is your Social Security number!
5. Date Notice Printed
This is the date the notice was printed for mailing. Medicare Summary Notices are sent out four times a year — once a quarter — but you don't have to wait for your notice to arrive in the mail. You can also check your account online at MyMedicare.gov. Claims typically appear on your electronic statement 24 hours after processing.
6. Did Medicare Approve all Services?
"YES" means that Medicare covers this type of health care service. If you see "NO" in this space, contact your provider and ask for an itemized statement. Also see the section "More information on how to handle a denied claim or file an appeal" (below). For more about noncovered services, see the article "What Medicare Doesn't Cover."
7. Total You May Be Billed
This is the maximum amount your doctor can bill you directly. It may include your deductible ($147 in 2013), your 20% coinsurance charges or any other expenses that Medicare does not cover. Compare your Medicare Summary Notice with the doctor's billing statement to make sure you are paying the correct amount. Contact your doctor if you spot errors in this section of your MSN.
If you have a Medicare supplemental insurance policy (often called “Medigap”), Medicare will send this claim information to your insurance company. Your supplemental insurance may cover some or all of the costs not paid by Medicare.
8. Your Deductible Status
Each year you must pay a deductible ($147 in 2013) for health services before Medicare begins to pay. This section shows how much of this annual deductible you have paid.
9. Provider for This Claim
Be aware that the name listed on your MSN might differ from your doctor's name. For instance, the name that appears here could be that of the medical practice or its owner. If you have questions, contact the doctor who is filing the claim. If the doctor's office cannot resolve your concerns, contact Medicare at 1-800-MEDICARE (1-800-633-4227).
10. Date of Service
This is the date or dates you received medical care. To make sure this information is correct, you can check your calendar or the statement you were given by the doctor's office at your visit. If you did not receive medical services on a date listed here, contact the doctor who is filing the claim. It could be a mistake that the doctor's office can easily correct. If the office cannot resolve your concerns,
contact Medicare at 1-800-MEDICARE(1-800-633-4227).
11. Doctor Name, Address and Phone
Be aware that the name listed on your MSN might differ from your doctor's name. For instance, the name that appears here could be that of the medical practice or its owner. The listed address might be for the doctor's billing office rather than the medical office. If you have questions, call the listed phone number to contact the doctor who is filing the claim. If the doctor's office cannot resolve your concerns, contact Medicare at 1-800-MEDICARE (1-800-633-4227).
12. Service Provided
This is a brief description of the provided service(s). If you did not receive a service listed here, contact the doctor who is making the claim. It could be a mistake that the doctor's office can easily correct. If the office cannot resolve your concerns, contact Medicare at 1-800-MEDICARE (1-800-633-4227).
13. Billing Code
Medical procedures and services are assigned billing codes. You have the right to receive an itemized billing statement that lists each medical service you received. If you need an itemized statement, contact your doctor. Compare the billing code on your MSN with the code that appears on the billing statement you received from your doctor. If the codes are different, or if you didn't receive the medical service indicated, contact the doctor who is making the claim. It may be a simple mistake that the doctor's office can easily correct. If the office does not resolve your concerns, call Medicare at 1-800-MEDICARE (1-800-633-4227).
14. Service Approved?
"Yes" means that Medicare covers this type of health care service. If you see "No" in this space, contact your provider and ask for an itemized statement. Also see the section "More information on how to handle a denied claim or file an appeal" (below). For more about noncovered services, see the article "What Medicare Doesn't Cover".
15. Amount Provider Charged
This is the amount the doctor billed Medicare.
16. Medicare-Approved Amount
This is the amount Medicare approved as an acceptable charge for this service. For more about noncovered charges, see the article "What Medicare Doesn't Cover." To challenge an unpaid charge, see the article "Appealing a Medicare Claim Decision."
17. Amount Medicare Paid
This is the amount Medicare paid to your doctor. In general, this amount is 80% of the Medicare-approved amount.
18. Maximum You May Be Billed
This is the maximum amount your doctor can bill you. It may include your deductible ($147 in 2013), your 20% coinsurance charges or other charges that Medicare does not cover. Compare your Medicare Summary Notice with the doctor's billing statement to make sure you are paying the correct amount. Contact your doctor if you spot errors in this section of your MSN.
19. See Notes Below
This column directs you to additional information about your claims. If there's a letter in this column, refer to the Notes for Claim Above (described by item No. 21).
20. Claim Number
Each claim, such as for a doctor visit, made to your Medicare Part B account is assigned a distinct number. Refer to this claim number when speaking with your provider or Medicare.
21. Notes for Claim Above
Medicare uses this area to give you extra information about the claims listed in your Medicare Summary Notice. For instance, the message shown here is about a Medicare supplemental insurance policy (also called "Medigap"). Medicare will send this claim information to that insurance company. The supplemental insurance may cover some or all of the costs not paid by Medicare.
22. How to Report Fraud
This section gives tips on how to protect against Medicare fraud. For more information, visit AARP.org/FightFraud
23. How to Handle a Denied Claim or File an Appeal
Follow the steps in this section if Medicare denies payment for a claim you think should have been paid.
Print a copy of your online MSN, which includes this appeal page, or use the form you get in the mail with your paper MSN.
Complete the form by hand. Be sure to make a copy of everything you send to Medicare. For more information about appealing a denial and deadlines for filing, see the article "Appealing a Medicare Claim Decision".
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