Medicare Questions

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 may be responsible before we bill Medicare. In fact, we cannot file claims until the other insurer has determined their responsibility. For example, if you are injured in an accident (in a car, at work or elsewhere), the hospital is required to bill those claims appropriately. Because of this, we need to have complete information about all of your insurance coverage.

If you enrolled in a Medicare Advantage plan, that plan is responsible for your medical claims. Medicare Advantage Plans are not the same as Medigap plans, or Medicare Supplements. Some Medicare Advantage Plans have provider networks and some may require that you obtain a referral for services. For more information on Medicare Advantage plans, please refer to Medicare's Medicare and You handbook. For information on how your Medicare Advantage Plan works, please contact your insurance plan or refer to the Evidence of Coverage supplied by your plan.

Do I have to sign any forms before Wheaton Franciscan Healthcare can bill Medicare?

We will ask you to sign a Consent for Treatment form each time you receive services in the hospital. For Covenant Clinic locations, you will generally sign the Consent for Treatment once per location. You will also be asked a series of questions each time you receive services. Medicare requires that we ask these questions to determine the insurance with primary responsibility for the claim.

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 a document that Medicare sends 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 your medical claims have been paid in full.

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

No. This amount may change depending on your individual insurance coverage. Please wait until you receive a bill from us before making payment.

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

As a Medicare patient, you will 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 any other health insurance for the balance. If you do not have other health insurance, you will receive a bill for the balance.

Will my service or visit be covered by Medicare?

Medicare covers medically necessary services and some preventive services. The preventive services coverage is often dependent on the frequency of the service. For specific benefit information, please refer to the Medicare website: www.Medicare.gov.

Why am I getting a bill for medications during an outpatient stay or service?

Medicare Part B does not cover drugs considered to be self-administrable. This means that the patient could, in another setting, have taken the medication by him or herself. The types of medications considered to be self-administrable include tablets, inhalers, sprays, ointments, drops and some injectibles, such as insulin. These are generally the types of medicines you take at home.

We are required to bill Medicare for these non-covered items. After Medicare has processed our claim, you will receive a bill from the hospital for your portion, including the non-covered items. Most Medicare supplements also do not cover the self-administrable medications.

Please see your Medicare handbook, visit the Medicare website, or call Medicare if you have additional questions. The website address is www.Medicare.gov and the phone number is 1-800-522-8323.

What are Advance Beneficiary Notices ?

Medicare covers medically necessary services and certain preventive services. Please visit www.Medicare.gov for specific benefit coverage information.

An ABN, or Advance Beneficiary Notice, is used to inform you that Medicare may not cover a service because it does not meet their definition of medically necessary. The purpose of the form is to help you make an informed decision. For these services, you must be notified in advance that the service will likely not be covered. The notice must include what test or services will likely not be covered, as well as an estimate of the cost of those services. If you chose to have the test or service even though Medicare is unlikely to pay for it, you will receive a bill for the service(s) if Medicare does not pay for them. To view a blank ABN, click on the link:http://www.cms.hhs.gov/BNI/Downloads/CMSR131G.pdf.

Because Medicare is unlikely to pay for the service does not mean that you should not receive it. There may be a good reason your doctor ordered the service.

To notify you that a service is not a covered benefit under Medicare, you may also be given an Advance Beneficiary Notice. The notice is not required by Medicare, but is often given to remind Medicare beneficiaries of non-covered services. Common services excluded by Medicare are cosmetic services, such as skin tag removal. Because the service is not covered, you will receive a bill for the service. In some circumstances, you may also be asked to pay in advance for such services.

Why do I receive two bills when I see a Covenant Clinic physician?

Medicare patients seen by a Covenant Clinic physician are billed under Hospital-Based Physician status. This means that Medicare patients are billed in two parts - a physician fee billed by Covenant Clinic and an outpatient facility services fee billed by Covenant Medical Center. Questions can be directed to (319) 272-1932 or (319)272-1933.