|  | Healthcare Industry | Medicare

What Happens If Medicare Does Not Pay the Entire Bill?

Medicare is a federal program that pays for health expenses for people age 65 and older. If Medicare does not pay for a claim, the beneficiary may pay out of pocket or appeal the denied claim.

  1. Out-of-Pocket Expenses

    • If Medicare does not pay the entire bill, beneficiaries may face significant out-of-pocket expenses. Beneficiaries may wish to consider Medicare supplemental insurance to pay for services not covered under the Medicare program.

    Appeals

    • If Medicare does not pay for an item or service, the beneficiary may file an appeal of the claim with the Medicare program. Beneficiaries may find appeal information in the explanation of benefits or the summary notice issued by the entity processing the Medicare claims.

    Medicare Managed Care Plan Appeals

    • Beneficiaries may appeal service denials they believe should be covered under a Medicare Managed Care Plan with their insurer. The insurer reviews an initial appeal and, if denied, the beneficiary may file a second appeal with an independent review organization.

    Medicare Prescription Drug Benefit Appeals

    • Beneficiaries may also appeal the denial of a Medicare Part D prescription drug benefit. The insurer is required to answer a standard appeal within seven days and urgent cases within 72 hours, in an expedited appeal.

    Bankruptcy

    • Sadly, many seniors may be unable to pay for health care bills not covered by the Medicare program. Many seniors, as a result, may be forced to file bankruptcy when faced with significant medical debt.

Medicare - Related Articles