Talking with your insurance company

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2 Talking with your insurance company If you have questions about your Medicare coverage, you have the right to get answers. You can call Medicare or your Medicare Advantage plan for information about how it s covering services you received. Here are some tips to help you get the best results from your phone call. Before you call Look at all statements you get from Medicare or your Medicare Advantage plan. Read over the list of common insurance terms on the back of this sheet. The person you speak to might use some of these words. Have the following information ready: A list of your questions During your call Take good notes. Record: The name and extension of the person you spoke to. You can ask to speak to the supervisor if they can t help you. You can ask Medicare or your plan to mail you information relating to the call Medicare Rights Center Helpline: Your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) will summarize health care services you ve recently received. MSNs will be mailed to you every three months, while EOBs are typically sent out by your private plan as often as every month. They ll say whether Medicare or your plan covered the services, and what you might be billed. If you don t understand or agree with something on the statement, call Medicare or your plan. The phone number should be on the statement. Your Medicare number or member ID number for your Medicare Advantage plan The name and address of the provider that billed Medicare

3 The amount you re being charged The diagnosis code of the service The date and time of the call What you were told and what you should do

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5 Premium: The monthly fee you pay to have insurance. Deductible: The amount you must spend on health care or drugs before your insurance begins to pay. Coinsurance / Copayment: The amount you must pay for each service or item. A copayment or copay is a fixed amount. Original Medicare: The fee for service health insurance program run by the federal government. Original Medicare consists of: Part B covers outpatient services and is also called medical insurance. Medicare Advantage plans: Private plans that provide Medicare health benefits and usually drug benefits. The most common kinds of Medicare Advantage plans are HMOs and PPOs. Terms to Know When You Talk With Your Insurer Referral: A formal recommendation from your primary care doctor to get services from another doctor or specialist. Some Medicare Advantage plans require a referral when you get care from someone other your primary care doctor. Part D: Medicare drug coverage. Medicare Summary Notice (MSN): A notice that lists health services you received that were billed to Original Medicare over the past three months. The MSN isn t a bill. Explanation of Benefits (EOB): A notice that lists health services you received that were billed to your Medicare Advantage plan. The EOB isn t a bill Medicare Rights Center Helpline: A coinsurance is a percentage of the total cost. Part A covers inpatient services and is also called hospital insurance. Prior Authorization: A requirement to get prior approval before getting certain services, items or drugs.