The Medicare claims and appeals process can seem daunting.  If you have tried to work with Medicare, and have run into problems, I might be able to help.  Although we cannot order an agency to decide a matter in your favor, we can ensure that your case is treated fairly and expeditiously. Once you have contacted my office regarding your case, you might be asked to fill out a privacy release form and send it with the explanation of the problem you are having to:

The Honorable Joe Barton
6001 West I-20, Suite 200
Arlington, TX 76017-2811

 

Frequently Asked Questions:

Q: How can I contact Medicare?
A: Medicare is is a branch of the Centers for Medicare and Medicaid Services (CMS), and falls under the Department of Health and Human Services.  You can contact Medicare by phone, or you can visit their website for more information.

 

Q: How do I sign up for Medicare benefits?
A: Some people get Part A and B automatically.  If you are already recieving benefits from Social Security or Railroad Retirement, you will automatically get Part A and B the first day of the month you turn 65.  If you are automatically enrolled, you will recieve a red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability benefits.  I fyou don't need Part B, follow the instructions that come with the card and send the card back.

Some people have to sign up for Mediacre Part A and/or B.  If you do not fall under automatic enrollment, contact Social Security 3 months before you turn 65 at 1-800-772-1213.  You can also apply online at www.socialsecurity.gov/retirement.  

 

Q: When is "medical transport" covered by Medicare?
A: Medicare Part B (Medical Insurance) covers ambulance services to or from a hospital, critical access hospital (CAH), or a skilled nursing facility (SNF) only when other transportation could endanger your health. In some cases, Medicare may also cover ambulance services in the following situations:

  • If you need to go from your home or a medical facility to get health care for a health condition that requires you to be transported by ambulance.
  • If you have End-Stage Renal Disease, need dialysis, and need ambulance transportation to or from a dialysis facility because other transportation could endanger your health.

Medicare will only cover ambulance services to the nearest appropriate medical facility that's able to give you the care you need. If you choose to be transported to a facility farther away, Medicare's payment will be based on the charge to the closest appropriate facility. If no local facilities are able to give you the care you need, Medicare will pay for transportation to the nearest facility outside your local area that's able to give you the care you need.

More details on Medicare coverage of "medical transport" can be found here.

 

Q:What is the difference between inpatient and outpatient status?
A: Your hospital status—whether you're an inpatient or an outpatient—affects how much you pay for hospital services (like X-rays, drugs, and lab tests) and may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF).

  • Your inpatient stay begins on the day you're formally admitted to the hospital with a doctor's order. That's your first inpatient day. The day before you're discharged is your last inpatient day (the day of discharge doesn't count as an inpatient day).
  • You're an outpatient if you're getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays, and the doctor hasn't written an order to admit you to the hospital as an inpatient. In these cases, you're an outpatient even if you stay in the hospital overnight in a regular hospital bed.

If you're in the hospital more than a few hours, always ask your doctor or the hospital staff if you're an inpatient or an outpatient. 

Q: Where can I find more information on Medicare benefits and proceedures?
A: Medicare has an extensive and informative website.  If you cannot find the information you need on the web, you can contact Medicare by phone.

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