SMP Corner
What if I am billed for my preventive care? You should carefully review your Medicare Summary Notices (MSNs) and/or Explanation of Benefits (EOBs) for any suspicious charges. If you think you were charged for a preventive service and should not have been, contact your health care provider first. Some providers are not familiar with the full list of Medicare- covered preventive services, and they may have made a simple mistake that can be corrected. Claims summaries and medical bills can be confusing, so it is usually a good idea to ask your provider questions before reporting activity as fraudulent.
Who do I contact with Medicare questions? Your doctor or other health care provider: If you would like to schedule preventive service, contact your doctor or health care provider. Additionally, reach out to your doctor or health care provider first if you believe you were inappropriately charged for a preventive service. State Health Insurance Assistance Program (SHIP): Contact your SHIP if you would like to learn more about how Medicare covers preventive services or if you are confused about why a provider is charging you for preventive care. SHIP counselors are certified and trained to provide individualized, unbiased Medicare information. Senior Medicare Patrol (SMP): Contact your SMP if you believe a provider is fraudulently billing you for preventive services. SMPs empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse. Medicare: Contact Medicare if you have questions about which preventive services Medicare covers, what eligibility criteria have to be met for certain services, and how to find a Medicare-participating provider. You can call Medicare at 1-800-MEDICARE (800-633-4227) or find information at www. Medicare.gov. (If you have a Medicare Advantage Plan, contact your plan to learn about their in-network providers.)
Why am I being charged for this service? Was there an error made?
You may be charged additional fees for certain services related to preventive care. For example: You may have costs for part of a preventive care visit if your doctor makes a diagnosis during the visit or conducts additional tests or procedures. Doctors do diagnostic tests and procedures when patients have distinct symptoms or a condition or history of that condition. For example, if your doctor finds and removes a polyp during a colonoscopy, the colonoscopy is diagnostic care and costs will apply. You may owe a facility fee depending on where you receive your preventive care service. For example, certain hospitals will often charge separate facility fees when you are receiving a preventive service.
If you still believe you are experiencing potential abuse, fraud, or being charged for a service you never received, you can contact your local Senior Medicare Patrol (SMP). SMPs are trained to help you prevent, detect, and report health care fraud, errors, and abuse.
Page 6 | April 2022, Never Too Late
Pima Council on Aging
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