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How to Read Your Part B Medicare Summary Notice (full text)

AARP's "decoder" shows you what you need to know

Reviewing your quarterly Medicare Summary Notice (MSN) is important, but understanding it can be a challenge.

See also: Understanding your Medicare statement.

That's why AARP has created two easy-to-use MSN "decoders": one for Part A and the other for Part B. The text below is a printable version of what appears within the pop-up boxes of AARP's Part B Medicare Summary Notice Decoder.

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 800-772-1213 (TTY 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 mailed. 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. Go to the section “How to Handle a Denied Claim” (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. It may include your deductible ($140 in 2012), your 20 percent 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 (also 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 ($140 in 2012) 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 800-MEDICARE (800-633-4227).

10. Date of Service: This is the date or dates you received medical care. To make sure the dates are 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 800-MEDICARE (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, contact the doctor who is filing the claim at the listed phone number. If the doctor’s office cannot resolve your concerns, contact Medicare at 800-MEDICARE (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 800-MEDICARE (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 or health care provider. 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 800-MEDICARE (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. Go to the section How to Handle a Denied Claim (below). For more about noncovered services, see the article "What Medicare Doesn't Cover."

15. Amount Provider Charged: This is the amount the doctor or health care provider 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 percent 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 ($140 in 2012), your 20 percent 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 talking 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.

If you have a Medicare supplemental insurance policy (also 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.

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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