Filing a Claim

It is important to file claims properly. The following list will help:

  • Keep an accurate record of all your health care expenses with your health insurance policies. Store this information with your Medigap insurance or other health insurance policies.
  • Whenever you receive treatment, present your Medicare card and any other insurance card you have.
  • File all claims promptly. With each claim payment from Medicare, you will receive a "Medicare Summary Notice" (MSN). If the insurance company requests a copy of the MSN, make a copy of the MSN and write down the date you send the copy to the insurance company. Keep copies of any information you have concerning services received, the dates of services, and the persons who provided the services.
  • You do not have to submit your claims to Medicare. Your doctor, supplier, or other Medicare provider must submit claims to Medicare for you.
  • If you enroll in a health maintenance organization (HMO), you will not have to file claims for services covered by HMO providers. All claims for covered services will be handled by the HMO.
  • Some Medigap insurance companies have an automatic claims filing program. This means that the insurance company receives a copy of your claim directly from the Medicare fiscal intermediary. There may be a charge for this service.
  • For more information on filing claims, you may want to contact the County or Tribal Benefit Specialist at your Regional Area Agency on Aging.

Note: Under Wisconsin law, all Medicare supplement and Medicare select insurance policies must include a benefit appeal procedure for claims denials. This procedure will be explained in your policy and Outline of Coverage.

Medicare and supplemental insurance claim filing has been simplified in recent years. Providers must submit your Medicare claims for you. If your doctor accepts assignment, Medicare will send your Medigap claim directly to your insurance company.