Plan F Medicare Claim

I think it is a safe bet to assume that no one likes dealing with medical claims.  Whether they be a Medicare claim or just a normal claim through other group or individual insurance, claims are pretty much a miserable process   Today, Medicare Insurance Finders is going to cover some of the basics with a Medicare claim (specifically some of the issues with a bill that you could be required to handle).

What does a Medicare Claim Form look like?

Below is a picture of a a generic claim form that a doctor’s office would complete.  It has the basics of an individual’s information, doctor’s information and the procedure provided.

Medicare Claim Form

A generic claim form that may be used by providers for Medicare beneficiaries.

 Medicare Claims Issues with a Plan F

In brief a Plan F is a Medigap policy that fills in all the gaps of Original Medicare.  It comes in and pays all the deductibles, copays, coinsurance and other costs associated with Medicare Claims.  You are also allowed to go to any doctor or hospital that accepts Medicare with these plans.

We have seen an increase of mis-coded claims over the last few years.  We are not providers so we do not know if this is due to more codes, more difficulty in coding procedures correctly, or if there are other issues that we have no idea of.  However, we can tell you that if you have a Plan F and receive a Medical claim do not just write a check for the amount.

Claims with a Plan F Medicare Supplement should be covered 100%.  If they are not there could be one of two common issues:

  1. Medicare did not cover the claim.  If you are receiving a procedure that is not medically necessary according to Medicare and their billing codes then the claim will not be covered by Medicare which in turn means that Medicare Supplement company will not be able to “supplement medicare”.  For supplemental quotes click here(Guaranteed Issue options available).
  2. The claim was coded incorrectly.  Many times someone can just code the claim incorrectly which sends an automatic rejection from Medicare.  Unfortunately, this may require you to handle some of the claims process.  Not much of course, but you will be required to call your doctor and ask them to re-file the claim.  This will probably be their mistake but do not be upset with them b/c there are thousands of codes and it is easy to get confused.

Medicare Insurance Finders providing Medicare claims information that matters.  Contact Medicare Insurance Finders at 1-800-800-1397 option 6 for              Insurance Rates.