Understanding health insruance paperwork

Silver Tips is written by the Senior Citizens’ Law Office in Albuquerque.

Consumers receive a lot of paperwork when they use health care services, and it can be very hard to understand the differences in the papers. If you have Medicare and a supplemental insurance, you may receive three different types of paperwork-provider bills, Medicare Summary Notices, and Medigap insurance notices.

Provider bills are itemized statements from health care providers (doctors, hospitals, and so forth). They list what services were provided and when, and what their charges are for those services. Provider bills do not always show what you will actually have to pay. This is because bills sent out shortly after you receive the care won't show what the provider will be paid by Medicare or other insurance. Providers should later send updated statements indicating what Medicare paid and how much the patient owes. There are limits on the amount that providers can charge Medicare patients out-of-pocket.

Medicare Summary Notices (MSNs) are forms that Medicare's claims-processing companies send you after they have received your providers' bill. Many people mistakenly think that these notices are bills, but they are not. In fact, MSNs say "This Is Not A Bill" on the top of the page. An MSN shows you whether your provider's claim was approved by Medicare, why or why not, how much your provider was paid, how much you still owe, and what appeal rights you have. The notice will also tell you how much, if any, of your annual Part B deductible you still owe. It is important to compare MSNs with your provider's bills, to make sure you are not being billed for more than Medicare says you owe.

Medigap (Medicare Supplement) Insurance Notices are similar to MSNs. These notices show what was covered by your Medicare supplemental insurance, if you have it. The forms will vary from company to company. If you have Medigap insurance it pays second, after Medicare pays. Anyone can have difficulty understanding and organizing Medicare paperwork. Some helpful tips include:

• Read all paperwork carefully when you receive it

• Make sure you actually received the services being billed for

• Keep all your paperwork together in one folder, file, or drawer

• Group the notices together based on the dates of service

• Note that insurance forms may use different names for your providers

It is important to make sure you understand and agree with the information in the notices. If you want help in understanding insurance paperwork, contact the New Mexico Aging and Long-Term Service Department's "Seniors Saving Medicare" program toll free at 1-866-842-9230. Staff and volunteer insurance counselors will provide assistance at no charge. For more information, contact the New Mexico Aging and Long-Term Services Department's Health Insurance and Benefits Assistance Corps (HIBAC). The toll-free statewide number for HIBAC is 1-800-432-2080; residents of Bernalillo County can call HIBAC at 265-1244.