Nebraska Department of Insurance
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QUESTIONS AND ANSWERS
Q. Does Medicare pay the doctor? Why would a beneficiary receive a check from Medicare?
Most Medicare payments go directly to the provider. Beneficiaries receive the payment only when they pay the bill ahead of time or when the provider doesn't accept the approved amount. The Medicare claim statement tells who was paid and how much the beneficiary can be billed.
Q. If Medicare doesn't pay a claim, will the Medicare Supplement take care of it?
A Medicare supplement will not pay if Medicare doesn't approve the charges. However, some Medicare supplement policies cover extra services such as prescription drugs or foreign travel that are not covered by Medicare. In many cases, Medicare sends claims information directly to the supplemental insurance company. If this doesn't happen, the beneficiary can file the claim by sending a copy of the Medicare statement to their insurance company. One of the most important things to know is that beneficiaries always have the right to appeal. If the beneficiary disagrees with the amount Medicare pays, or Medicare denies the claim, check with the provider to see if the claim was filed properly. If this doesn't solve the problem, the Medicare statement explains how to appeal a claim and the time limit for appealing.
Q. Is COBRA insurance?
COBRA is not insurance. COBRA is the name (or acronym) of the federal law that requires continuation of employer health insurance. It is the law, since 1985. COBRA allows employees and their dependents to continue employer group health insurance for several months when the insurance would usually end. When you become eligible for Medicare, COBRA coverage ends. For answers to specific COBRA questions, contact the Department of Labor in our Region, 816-426-5131.
I stopped believing in Santa Claus when my mother took me to see him in a department store, and he asked for my autograph.
Shirley Temple
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