26. Amount Charged: This is the total amount the facility billed Medicare for the service or treatment.
27. Noncovered Charges: Medicare doesn't cover all of your medical expenses. For example, Medicare does not pay for copies of X-rays or the first three units of blood used in a transfusion. (For more about noncovered charges, see "What Medicare Doesn't Cover." To challenge an unpaid charge, see "Appealing a Medicare Claim Decision.")
28. Deductible and Coinsurance: Your outpatient services fall under your Medicare Part B deductible. This is the amount of money you pay out-of-pocket before Medicare helps with the costs. After you have met the annual deductible ($162 in 2011), you pay 20 percent of the Medicare-allowed fees for later charges.
Depending on the services you receive, you may also be charged a co-payment. For example, if you visit an emergency room and are not admitted to the hospital, you pay a co-payment directly to the hospital.
29. You May Be Billed: This is the maximum amount the hospital or facility can bill you. It can include your deductible and coinsurance or other charges Medicare does not cover. If you have Medicare supplemental insurance (also called Medigap), Medicare will send this claim information to your insurance company. Your Medigap policy should cover at least some of the costs not paid by Medicare.
30. See Notes Section: This column directs you to additional information about your claims. If there's a letter in this column, refer to the Notes Section (described by item No. 32) at the end of your Medicare Summary Notice.
31. 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 what you paid matches the amounts on your Medicare Summary Notice. If you paid more than needed, contact the provider's billing office.
32. Notes Section: Medicare uses this area to give you extra information about the claims listed in your Medicare Summary Notice. If a letter code appears in the column called "See Notes Section," you'll find an explanation of that code here.