RAO Davao City

United States Military Retiree Activities Office Davao City, Philippines


Posted by Service Officer on July 3rd, 2008

When Medicare processes a claim for health care services you received, the claim is detailed in a Medicare Summary Notice (MSN). It is a summary of claims for health care services Medicare processed for you during the previous three months. They are mailed four times a year and contain information about submitted charges, the amount that Medicare paid, and the amount you are responsible for. The most important fields on your MSN explain:


• You May Be Billed: This field indicates the total amount that the provider is allowed to bill you (balance billing). It deducts the amount you already paid. In many instances, Medicare forwards your MSN to your supplemental insurer, which may pay this amount in full or in part. Sometimes, you may be responsible for a portion of the balance which neither Medicare nor your supplemental insurance has paid. Note: You should ignore the “Amount Charged” field.

• Non-covered charges, if any: This field shows the portion of charges for services that are denied or excluded (never covered) by Medicare. A $0.00 in this field means that there were no denied or excluded services. If you disagree with a non-covered charge, you can appeal.

You are encouraged to save your MSNs for about seven years. You might need them in the future to prove that payment was made if a provider sends you a bill or that services were received if you claimed a medical deduction on your taxes. If you have lost your MSN or you need a duplicate copy, call 800-MEDICARE. You will be redirected to the Medicare carrier who originally issued the MSN and can send you a copy.

When you receive your (MSN) or your Explanation of Medicare Benefits (EOMB) if you are in a private health plan, look at it carefully to make sure that you actually received all the services listed. Sometimes this can be hard to do if you received services from several doctors at the same time. The MSN is not a bill but is a useful tool to help identify Medicare fraud. Some other ways to help identify fraud are:

1. In selecting providers or receiving care you should be suspicious of people who tell you they represent Medicare and want to offer you a service for free; call you or visit your house to offer services or equipment; offer “free consultations” only to people with Medicare and ask for your Medicare number.

2. At your doctor’s office your doctor should not charge a coinsurance for most preventive services, such as pap smears or flu shots, offer tests or other services that you don’t need, especially if the doctor says that the more tests you receive, the cheaper they are, are fail to charge a coinsurance all the time. Doctors can sometimes forgive a coinsurance if a patient is in great financial need, but they should not do this routinely.

3. If you have returned your Durable Medical Equipment, your supplier should not continue to charge Medicare for rental fees or maintenance. These charges would appear on your MSN or EOMB.

[Source: Medicare Rights Center Jun 08 ++]

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