Before you call a medical billing office, gather the bill, your Medicare Summary Notice (MSN) or Explanation of Benefits for the same date, and your Medicare card. Open by giving the account number and date of service, ask one specific question, and ask for any fix in writing. Write down the date, the person's name, and what they agreed to, and ask them to hold the account while they look into it.
What should I have ready before I call?
- The bill, with the account number and the billing phone number.
- Your Medicare Summary Notice (MSN) for the same date, or your plan's Explanation of Benefits (EOB). You'll want the "Maximum You May Be Billed" or "your share" amount.
- Your Medicare card and any Medigap or other insurance card.
- An itemized bill, if you have one.
- A pen and a call log (see below).
- The patient, if you're calling for a parent. In general, offices need the patient's OK before they'll discuss the account with you. Ask what they accept.
Call at a time when you can spend 20 to 30 minutes without rushing.
How do I open the call?
"Hi, my name is [your name]. I'm calling about a bill for [patient name], date of birth [date]. The account number is [number], and the date of service is [date]. Do you have a moment to help me understand this bill?"
If you're calling for a parent:
"I'm calling on behalf of my mother/father, [name]. They're here with me and can give permission for you to speak with me." (Then hand the phone over briefly.)
Ask for the person's name early: "May I have your name in case we get disconnected?"
What do I say if the bill is higher than my Medicare notice?
"My Medicare Summary Notice shows the Medicare-approved amount was [amount], Medicare paid [amount], and the maximum I may be billed is [amount]. Your bill shows [amount]. Can you help me understand the difference?"
Follow-up questions:
- "Has Medicare's payment and adjustment been posted to my account?"
- "Do you accept Medicare assignment?" (Medicare.gov says providers who accept assignment agree to charge only the deductible and coinsurance.)
- "Has the claim been sent to my Medigap plan, [company]? Has it paid?"
What do I say if I don't recognize a charge?
"I see a charge for [description, code] on [date]. I don't remember getting this service. Can you tell me what it was for and who ordered it?"
If it still doesn't make sense:
"Can you send me an itemized bill and check the charge against my medical record?"
The Centers for Medicare & Medicaid Services (CMS) guide to checking bills suggests comparing your bill to your medical records and asking the billing department about anything not documented.
What do I say about a duplicate charge?
"I see [description], code [code], on [date], listed twice at [amount]. I only received it once, and my Medicare notice shows it once. Can you remove the duplicate and send me a corrected statement?"
What do I say if Medicare denied something?
"Medicare denied [service] on [date]. The note on my Medicare Summary Notice says [reason]. Can you check whether the claim had the right codes and diagnosis? If there was an error, can you correct it and resubmit?"
If they say the claim was correct:
"I'm planning to appeal. Can you send me any records or a letter from the doctor that would help? Will you hold the bill while my appeal is pending?"