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Re: Is there a chart somewhere that tells me what Medicare covers?

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@ASTRAEA wrote:

@john258 - That sounds very round-about; calling AARP to get the name of local Medicare "experts"! I still don't know exactly what makes these people "experts" .. and I surely don't intend to pay anyone to get a straight answer on how Medicare calculates payments on claims.


If you do not know any experts in your area then  you can get information on where to find one from AARP in you area. That way you will get your questions answered, and help if you need it.

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Re: Is there a chart somewhere that tells me what Medicare covers?

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Message 2 of 18

@john258 - That sounds very round-about; calling AARP to get the name of local Medicare "experts"! I still don't know exactly what makes these people "experts" .. and I surely don't intend to pay anyone to get a straight answer on how Medicare calculates payments on claims.


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Re: Is there a chart somewhere that tells me what Medicare covers?

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Message 3 of 18

@ASTRAEA wrote:

@john258 - I am personally not looking for "advice" here, but if someone had figured out how their calculations & statements work. I'm not sure what sort of "local expert" you're referring to, but I do know from having visited the local Social Security office with some questions about Medicare premium billing, they told me I'd have to contact Medicare directly, for questions about claims & EOBs.


Great as you will not get good advice in here. Call your local AARP Office as they should be able to give you the names of some local experts who can guide you through billing etc.

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Re: Is there a chart somewhere that tells me what Medicare covers?

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Message 4 of 18

@byrondennis wrote:

Also the government claims the major purpose of these notices is to make sure that we actually received the service(s) listed and that there is no fraud or improper payment in progress (either false or improper billing by the provider or someone stealing our identity). The government should probably just drop the dollar amounts altogether.

As long as I'm on the hook for any payment, I want to know exactly how much Medicare & my supplemental insurance is paying service providers!


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Re: Is there a chart somewhere that tells me what Medicare covers?

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Message 5 of 18

@byrondennis - Yes, I just have parts A & B, and was told I'd get the statements (similar to EOBs) quarterly. I may have mentioned earlier (or elsewhere), that in talking to 2 phone representatives, I got 2 totally different answers, about premium payments .. and a different - but thankfully more understandable - answer from a representative at the local SS office! He explained that if you're not yet getting SS, you're billed quarterly for your Medicare premiums, but once you're getting SS those premiums are deducted monthly. That said, he told me I'd be getting my next bill "soon", with the correct premium amount, and that was a month ago!


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Re: Is there a chart somewhere that tells me what Medicare covers?

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Message 6 of 18

@ASTRAEA wrote:

@cd19264779 wrote:

Hi 

Have you gone to my Medicare web page? You should have received info on all that is covered or you can call and request info.


@cd19264779 - I'm not sure to whom your comment was addressed, but I don't have all day to search thru all the material Medicare has on their website, to get an answer to a very specific question. I'd want a representative to be able to pull up a couple of my claims, and walk thru the process calculating how much was paid & the max for which I could be billed.


Astrea

 

I think @cd19264779 is referring to the "myMedicare" page that is unique to you, not to all the material Medicare has on its website. I do not use it (because per my other reply to you, I use Parts A/B/C) so I can't be sure but I think the "myMedicare" page is just an electronic version of the printed, mailed Medicare Summary Notice.

 

Also the government claims the major purpose of these notices is to make sure that we actually received the service(s) listed and that there is no fraud or improper payment in progress (either false or improper billing by the provider or someone stealing our identity). The government should probably just drop the dollar amounts altogether.

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Re: Is there a chart somewhere that tells me what Medicare covers?

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Message 7 of 18

@ASTRAEA wrote:

@byrondennis - I wish their EOBs were more clear; I got my first last week. Although it showed that Medicare "covered" the full amount each of the providers billed, that wasn't the amount they actually paid .. per Medicare's rate schedule .. which ISN'T shown on the statement! And then they allegedly cover 80% of what's on their rate schedule .. but when I look at my supplemental's EOBs, their payments aren't 20% of what that Medicare rate schedule should be, if you work backwards from the 80% they've paid!


Astrea

 

In my opinion a big part of the problem is that the Trustees do not even use the same terminology and formats for the differert Parts of Medicare. Are you referring to the Medicare Summary Notices that come out quarterly for people with just Parts A and/or B?  I have Parts A/B/C and my C plan sponsor sends out two EOBs monthly (one for medical services and one for drugs) even if I do not go to the doctors or buy any drugs. I think people with just Parts A and/or B and D and a private supplment also get two or three different sets of explanatory notices.

 

I was able to get the Part C sponsor to send me the medical services notice only be email but apparently that is not possible for the drug part of my coverage. So they waste a ton of paper sending me 7 pages of blah blah blah that tells me that they paid nothing to the drug store for my $10 bottle of atenolol. On the other hand it was both interesting and satisfying last year to see that the hospital and doctor wanted $20,000 for an outpatient operation I had but were willing to accept just $2000 from the sponsor and that I only owed $200.

 

I think this is an issue for people not yet on Medicare as well?

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Re: Is there a chart somewhere that tells me what Medicare covers?

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Message 8 of 18

@cd19264779 wrote:

Hi 

Have you gone to my Medicare web page? You should have received info on all that is covered or you can call and request info.


@cd19264779 - I'm not sure to whom your comment was addressed, but I don't have all day to search thru all the material Medicare has on their website, to get an answer to a very specific question. I'd want a representative to be able to pull up a couple of my claims, and walk thru the process calculating how much was paid & the max for which I could be billed.


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Re: Is there a chart somewhere that tells me what Medicare covers?

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Message 9 of 18

@john258 - I am personally not looking for "advice" here, but if someone had figured out how their calculations & statements work. I'm not sure what sort of "local expert" you're referring to, but I do know from having visited the local Social Security office with some questions about Medicare premium billing, they told me I'd have to contact Medicare directly, for questions about claims & EOBs.


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Re: Is there a chart somewhere that tells me what Medicare covers?

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Message 10 of 18

Hi 

Have you gone to my Medicare web page? You should have received info on all that is covered or you can call and request info.

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