Medicare Corner
Medicare and Health Insurance Marketplaces What is a Medicare billing error?
A Medicare billing error is an honest health care service or product mistake related to billing. While transitioning from the Marketplace to Medicare, your provider could mistakenly bill claims to the wrong insurance plan. A pattern of errors by a physician or provider could be considered a red flag or potential fraud or abuse if it is not corrected. Read your Explanation of Benefits (EOBs) and Medicare Summary Notices (MSNs) carefully to detect any potential errors. If you see anything incorrect, or receive a suspicious bill, first contact your provider. Sometimes providers may make billing mistakes, which they can correct. If the problem continues, contact your Senior Medicare Patrol (SMP). Who to contact for more information • State Health Insurance Assistance Program (SHIP): Contact your SHIP if you have questions about Medicare coverage and how to transition from a Marketplace plan. It may be helpful to also contact your SHIP if you are eligible for Medicare due to ESRD and choosing between Medicare and a Marketplace plan (also known as a QHP). • Senior Medicare Patrol (SMP): Contact your SMP if you have experienced potential Medicare fraud, errors, or abuse. SMPs can provide you with information to prevent, detect, and report such experiences. • Marketplace: Contact your health insurance Marketplace to disenroll from your Marketplace plan. If you are enrolled in a plan through the federal Marketplace, you can call 800-318-2596 or visit www.healthcare.gov. If you are enrolled in a plan through your state’s Marketplace, contact it directly to learn how to disenroll. • Employer: If you are enrolled in a SHOP plan through your employer, speak to your employer about how your insurance will work once you are enrolled in Medicare. If your employer is unsure, you can reach out to your SHIP. • Social Security Administration (SSA): Enroll in Medicare through SSA. You can visit or call your local Social Security office, call the national SSA number at 800-772-1213, or create your secure my Social Security account at www.ssa.gov to enroll. Pima Council on Aging is your local SHIP and SMP. Call (520) 546-2011 or email SHIP@pcoa.org for assistance.
Page 6 | January 2023, Never Too Late
Pima Council on Aging
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