I have Original Medicare, and I just received a document that lists the procedures I’ve gotten from my doctors in the past few months. It says, “This is not a bill.” What am I supposed to do with it?

-Constance (Santa Fe, NM)

Dear Constance,

It sounds like the document you are looking at is the Medicare Summary Notice (MSN). The MSN is a document that is sent to people with Original Medicare. It is a summary of health care services and items you have received during the past three months. The MSN is not a bill. The contractor that processes your claims from Medicare will send you the MSN, so it may have the name and address of a private company on it.

MSNs are usually mailed four times per year and contain information about charges billed to Medicare, the amount that Medicare paid, and the amount that you are responsible for. Note that you may receive additional MSNs if you receive reimbursement for a bill you paid.

In addition to the health care services you received in a given quarter, your MSN lists:

• The amount providers billed Medicare for those services (Note: the “Amount Provider Charged” field does not show your costs.)
• In an MSN for Part A services, the date that your benefit period began and the benefit days you have used in that benefit period.
• The Medicare-approved amount for each item or service. This is the amount that Medicare law sets as the price for an item or service.
• The amount Medicare paid providers for each service. This is a portion of the Medicare-approved amount. For most Part B-covered services, the “Amount Medicare Paid” is 80% of the Medicare-approved amount. For many preventive services, the “Amount Medicare Paid” is 100% of the approved amount.
• The amount you may need to pay directly to providers (indicated in the “You May Be Billed” section). Note that you will receive a bill from providers and do not need to pay anything unless you have received a bill.
• Any non-covered charges. This column shows the portion of charges for services that are denied or excluded (never covered) by Medicare. A $0.00 charge in this section means there were no denied or excluded services. A charge in this section typically means that you are responsible for paying it. If you disagree with a non-covered charge, you should file an appeal. For assistance with filing an appeal, you should contact your local State Health Insurance Assistance Program (SHIP). If you do not know how to contact your SHIP, you can call 877-839-2675 or visit www.shiptacenter.org.
• Notes for the claims included on the MSN. These notes might indicate that claims have been sent to your supplementary insurance for secondary payment. For denied claims, the notes will provide explanation about why the item or service was denied. These explanations are important, especially if you are proceeding with an appeal.

In many instances, Medicare or your provider forwards your MSN to your secondary insurer (if you have secondary insurance), which may then pay all or some of the remaining costs. Check the notes on your MSN because they may indicate if a claim has already been sent to another insurer. If not, you may need to submit a claim yourself. Call your secondary insurance plan to learn what (if any) steps you need to take, and speak to your provider to ensure that they have your most up-to-date insurance information.

When you receive your MSN, you should review it to make sure that it is accurate, and that you actually received the services and items on the dates of service listed. If there is any incorrect information (like, for example, if your MSN lists a service that you did not receive), you should call the listed provider to check if their office made a billing error. If you suspect that a provider is intentionally billing Medicare for services they did not deliver, that someone is using your Medicare number or card, or that some other form of fraud is occurring, you should contact your local Senior Medicare Patrol (SMP). Your SMP will be able to help you identify fraud and, if necessary, report it to the proper authorities. To contact your SMP, call 877-808-2468 or visit www.smpresource.org.

After you have reviewed your MSN, you should keep it somewhere safe. You may need it in the future to prove that payment was made if a provider’s billing department makes a mistake or if you claimed a medical deduction on your taxes. If you lose your MSN or need a duplicate copy, call 1-800-MEDICARE or go to your account on www.mymedicare.gov.

-Marci

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