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How to Make a Medicare Claim
Friday, 26 March 2021

Filing a Medicare claim is not an action that the majority of people will ever have to undertake themselves. However, in some situations, this may become necessary, and it is very helpful to know how to do this properly.

Failure to file a Medicare claim properly could result in a delay to your pay-out or prevent you from being able to make a claim entirely. If you need help with making a claim, then it is a good idea to speak to a friend or family member or contact a relevant support service.

Although it might seem daunting to make a Medicare claim yourself, this is actually quite a simple and straightforward procedure.


What is Medicare?

For those who don’t already know, Medicare is a healthcare insurance program. It is a federal insurance that is primarily offered to people aged over 65 years old and people of any age with certain disabilities and health conditions.

Medicare Fraud

You must file your claim with accurate information and honest intentions. Medicare fraud is a serious crime, and people convicted of this crime can face lengthy prison sentences and hefty fines.

Filing Your Own Claim

It is normal to expect that your insurance provider will file a Medicare claim for you. If your provider is unable to file your claim, you may have to do it yourself. You may also want to file your own claim if you believe that your provider has not done it correctly.

Fill Out a Form

The first step you will need to take is to fill out a ‘Patient’s Request for Medical Payment’ form. This form is available on the Centers for Medicare & Medicaid Services website.
The form will ask you to confirm why it became necessary for you to seek health care, especially whether this was due to a workplace accident or injury. This form will also ask you to specify the details of your individual insurance plan.
If you are claiming health care received outside of the United States, you should be prepared to give full details about the specific care you require.

Itemized Billing

It will be important to submit an itemized bill when you are making a Medicare claim. If you did not receive one from your health care provider, then you should contact the relevant department to get one.
Ensure that your itemized bill includes the dates of your treatment and the names and addresses of the doctors responsible for your care.

Supporting Documents

Supporting documents will be very helpful for making a Medicare claim.
These documents might relate to relevant referrals from your primary care physician, as well as further relevant details of your medical history.

Send Your Forms

The final step is to send all of your forms to the right place. This must be done by mail as there is not currently an online process.
You can visit the Medicare website to find the correct address for the state in which you live.
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