What is a Medicare explanation of benefits form?
The explanation of benefits form is an information 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?
Keep the 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 it will pay any remaining balance on your account.
Will Medicare cover my outpatient procedure?
Yes. Medicare will pay for medically necessary acute care services ordered by your physician. There are many things your Medicare benefits will not cover (screening exam, preventive medicine services) and many services that must meet medical necessity screen, and the diagnostic reason stated by your physician.
In some cases you may even be required to sign an advance beneficiary notice indicating that you have been informed that Medicare will not cover the costs of certain services.
Do I have to sign any forms before Evergreen Healthcare 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.
I have health insurance in addition to Medicare coverage. Will Evergreen Healthcare bill that insurance company also?
Yes. Provide the information at registration about your additional health insurance and that insurance company will be billed after Medicare has made its payment.
Should I pay the balance that is listed as "your total responsibility" on the explanation of benefits form?
No. You will receive a bill from Evergreen and that should be the invoice to which you make your payment. Often there is more than one insurance and more than one EOB that could make up the final balance for which you will be responsible.
Will I have to pay any money for my visits?
As a Medicare patient, you could be responsible for some significant charges that are related to co-insurance, deductible and non-covered charge amounts. If you do not have a secondary or supplemental insurance coverage, please contact Patient Financial Services if your medical bill is a financial hardship.
Why am I being charged for the pills, inhaler, ointments, etc. that I normally take at home?
Medicare has never covered self-administered drugs if they are provided in an outpatient setting. As an excluded service the hospital must bill the beneficiary.
I was admitted to the hospital on one day but there are charges on the detail bill for a few days prior. Why?
The Medicare 72-hour rule says that the billing of outpatient services rendered just prior to an inpatient stay must be included on the inpatient bill.