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Frequently Asked Questions - Medicare

Here are some frequently asked questions and answers regarding Medicare.

Why do I have to give you information about other insurance if I have Medicare coverage?

Medicare requires us to bill any insurance company that could have responsibility for your expenses before we bill Medicare. In fact, Medicare will not allow us to file claims until the other insurer has denied claims. In certain situations, the hospital must consider the possibility that another party may be responsible for your expenses before we bill Medicare. For example, if you were injured in a car accident, at your worksite, or on someone else's property, it is the hospital's responsibility to make sure those claims are filed appropriately. Consequently, we need to have complete information about all insurance coverage you have.

Do I have to sign any forms before MercyCare Community Physicians can bill Medicare?

You will be asked to sign a Consent for Treatment form each time you receive services. You will also be asked questions each time you receive services that Medicare requires we ask. You may be asked to sign a patient waiver if the services are not covered by Medicare.

I have health insurance in addition to Medicare coverage. Will you bill that insurance company also?

If you have given us information about your additional health insurance, we will bill that insurance company after Medicare has made their payment.

What is a Medicare Explanation of Benefits form?

The Explanation of Benefits (EOB) form is an information document that Medicare send to you after it has processed your medical claims. The Explanation of Benefits form provides you with information about the payment status of your bill.

What is the difference between Part A and Part B Explanation of Benefits forms?

Part A covers inpatient hospitalization and Part B covers outpatient and physician services.

What should I do with the Explanation of Benefits form?

We recommend you keep the Explanation of Benefits forms you receive from Medicare until all your medical claims have been paid in full. If you have other health insurance in addition to Medicare coverage, your insurance company will normally require a copy of the Explanation of Benefits from you before they will pay any remaining balance on your account.

Should I pay the balance that is listed on "your total responsibility" on the Explanation of Benefits form?

No. This amount could change depending on your individual insurance coverage. You should wait until you receive a bill from your medical provider before making payment.

Will I have to pay any money for my hospital visits?

As a Medicare patient, you will only be responsible for non-covered charges, co-pays and deductible amounts. These amounts may vary depending on your Medicare coverage. We do not know what your payment may be until we receive the notification from Medicare. Once Medicare lets us know your responsibility, we will bill your other health insurance company (if you have coverage) for the balance. If you do not have other health insurance, you will be billed for the balance.