Before receiving care, ask your provider’s office whether they will submit your bill to Original Medicare. While they aren’t required to do so, some non-participating providers will still file your claims with Medicare.
The same situation applies for Medicare Advantage enrollees who see out-of-network providers. These providers don’t have to file claims with your Advantage plan, but may choose to do so. (Medicare Advantage enrollees can see out-of-network providers for routine care only if their plan includes out-of-network coverage, but all Advantage enrollees have coverage for out-of-network urgent and emergency room care. You may have to file your own claims when you receive any of these types of out-of-network care.)
If you have Original Medicare and a participating provider refuses to submit a claim, you can file a complaint with 1-800-MEDICARE. Regardless of whether or not the provider is required to file claims, you can submit the healthcare claims yourself. You can file an Original Medicare claim by sending a Beneficiary Request for Medical Payment form and the provider’s bill or invoice to your regional Medicare Administrative Contractor (Here is a list of these broken down by state). Keep copies of everything you submit.
(Original Medicare providers have to give you an advance beneficiary notice (ABN), Home Health Advance Beneficiary Notice, or Skilled Nursing Advance Beneficiary Notice if they believe Medicare will not cover your care. Providers normally will not bill Medicare after they issue an ABN.
You have the right to demand bill, which is when you demand that the provider or facility submit a claim to Medicare for your care. In order to demand bill, you must sign the ABN and agree to pay the charges if Medicare denies coverage. Demand billing can be used to generate a formal Medicare coverage denial, which gives you further appeal rights.)