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Understanding the Basics of Medicare Claims


Filing a claim is a rare case for Medicare beneficiaries. Nonetheless, you have to know the process if in case you have to do the filing instead of your care provider. Obviously, you have to be eligible for government-sponsored Medicare insurance before you can ask for payments or reimbursements.

  • Filing a Claim
    You can contact your healthcare provider to file a claim if you are covered with Original Medicare. If your doctor is a participating provider, he or she will be the one to process the claim. However, if your physician is a non-participating provider, you have to do the filing yourself. Fortunately, if you are a Medicare Advantage Plan (Part C) beneficiary, you don’t already have to file a claim.
  • Updating Your Claim
    Before filing your claim, it’s better to ask for assistance from reliable Medicare consultants in Pennsylvania to guide you. Claims for Original Medicare could last for 12 months while reimbursements for Medicare Advantage could be processed in a shorter period depending on your claim. Log in to your Medicare account or register to “Medicare Summary Notice” (MSN) to check the updates of your billing and claims.
  • Filing an Appeal
    After Medicare has made a decision, you can file an appeal if you believe the resolution is not fair. Your health insurance broker in Allentown, Pennsylvania may help you in the process to ensure that you get what you deserve. If you believe you’ve been denied with your Medicare coverage, healthcare plan, prescription plan, or Medicare Medical Savings Account (MSA) Plan, you can file an appeal with your healthcare provider.

For further assistance, please don’t hesitate to get in touch with us here at Medicare Professional Advisors. Talk to us at 800-518-3986 today!

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