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I’m Enrolled in a Medicare Advantage Plan and I got a bill that says I owe a provider. What should I do?

Medicare Advantage plans are continuing to grow in popularity among many Medicare beneficiaries, but many seniors struggle to understand the claims process and how many of their benefits are applied. Any time you see a healthcare provider, they’re going to file a claim to your Medicare Advantage plan and if you are responsible for any amount of the charges, you will receive a bill. If you receive a bill from your provider, how do you know if your truly owe that amount? Here are a few tips that will help you make that determination:

  1. Study your benefits. When you enrolled in your plan, you should have received a benefit booklet that details what your plan will pay for each service that would be rendered. For example, if you have a copay for visits to your Primary Care Physician, the amount you should pay will be listed in the summary of benefits booklet. If you receive a bill for a different amount, call the member services plan number listed on your ID card. If you have an agent that helped you enroll in your plan, you should be able to call your agent for help also.
  1. Review the Explanation of Benefits (EOB). When your Medicare Advantage plan processes your claims, they should periodically send you a statement that details the date that services were rendered, the charges they were billed, the amount they paid, and the amount you owe (if any). Compare the amounts listed on the EOB to any bills you receive from your healthcare providers. If there are any discrepancies, call Member Services to get an explanation before making any payments.
  1. Reach out to your agent for assistance. This is one of the reasons I always suggest Medicare beneficiaries work with a knowledgeable independent agent. If an agent helped you enroll in a plan, they should be able to assist you with problems or concerns. Also, a competent agent should have relationships with the Medicare Advantage plans that enable them to get answers a lot quicker than their clients could on their own. If you are working with a good agent, use them to your advantage.

If you have a unique claims issue and can’t seem to find the any help, reach out to us and let’s see if we can get you the help you need to resolve your issues.

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