Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
MARCH 2002 NICA NEWS
QUESTIONS AND ANSWERS
Q. Can a provider who does not accept assignment charge a fee to file a Medicare Part B claim?A. No. Regardless of whether a provider accepts assignment, providers CANNOT charge to file claims. If the provider sends the bill to the beneficiary and the bill shows a charge for filing with Medicare, the beneficiary should refuse to pay that portion of the bill and send a copy of the bill to Medicare Claims, PO Box 239, Topeka, KS 66629, showing that filing charge.
Q. Can a provider who does not accept assignment, bill the patient and tell the patient to file a claim with Medicare Part B?
A. Yes, although this rarely happens. A provider is supposed to file a claim, but may refuse and send the bill to the beneficiary. Ultimately, the beneficiary is responsible for paying the bill. If this happens, the beneficiary can file a claim with Medicare by sending the bill along with a note that the doctor refused to file the claim to Medicare Claims, PO Box 239, Topeka, KS 66629. For information regarding your claim, you may call toll free, 1-800-633-1113.
Q. What happens if a provider does not accept Sterling Option I, Private Fee For Service?
A. The provider will treat the beneficiary and then bill the beneficiary. Although, the beneficiary is ultimately responsible for the bill, the beneficiary will then send the claim to Sterling for payment, at Sterling Claims, PO Box 1917, Bellingham, Washington 98227-1917. You may also call the toll free number, 1-888-858-8551, for information regarding your claim.
Q. How can I order Medicare brochures?
A. The NICA Program Specialist, Rebecca Hasty, will be happy to send you Medicare brochures, free, postage paid, if you call and request them, 402-471-3845.
Q. My insurance company sent a check to me instead of the doctor. Should I endorse it and send it to the doctor's office?
A. No. Medicare and health insurance send payments directly to you for some claims. It can be tempting to endorse a check and send it to a provider as payment for a bill, but this may not be a good idea. Health care providers receive millions of checks from Medicare, other health insurance and patients. A few of them may not reach the proper place or can be lost. When that happens, you may need to prove you paid. Beneficiaries may have to pay a bill a second time. In one case a client endorsed the check he received from his supplemental insurance company and sent it to the doctor. Later the doctor's office showed no record of receiving the check and sent a bill for the unpaid balance. The client had no record of his payment. The client's insurance company couldn't produce a copy of the check, and the client had to pay the doctor's bill again.