Medicare Claims and Appeals in Pennsylvania


Filing a Medicare claim in Pennsylvania may be necessary if you received a service you believe should be covered by your insurance. Usually, a Medicare claim form will be filed by your doctor or health care provider when you receive a Medicare-covered service. However, you can also file claims when needed. It is important to note that Medicare claims are just one way that you can request a review of your billing or the services that you received. You can also file an appeal or a complaint about your Medicare coverage in appropriate situations. Be aware that claims, appeals and complaints are different and should be used under specific circumstances to bring attention to issues you are experiencing with your coverage or service. Learn how to file a Medicare claim form in Pennsylvania and find out how to check your Medicare claim status using various methods.

When would I need to file a Medicare claim in Pennsylvania?

Pennsylvania Medicare claims are usually only necessary for people who use Medicare Part A and Part B, otherwise known as Original Medicare. Medicare claim forms rarely need to be submitted for beneficiaries who receive care using Medicare Part C, more commonly referred to as Medicare Advantage. Claims are not typically required for these policies because they are provided by private insurance companies, which already receive funds from the Medicare program. In most cases, PA Medicare claims are filed by a doctor on behalf of a patient. However, there are a few situations in which a beneficiary would need to send in a claim on his or her own. These include:

  • If a doctor does not submit claims in a timely manner.
  • If a patient is billed for services that he or she thinks Medicare should pay for.
  • When Medicare patients receive care from foreign hospitals or aboard ships.

A Pennsylvania Medicare claim form needs to be filed within a certain timeframe for Medicare to address the issue. Officials cannot do anything about a Medicare claim if the notice is received after this set period. Download our comprehensive and free guide to find out when you need to have claims submitted to Medicare by.

How to File Medicare Claims in Pennsylvania

Claims for Medicare in Pennsylvania can only be submitted through the mail. You cannot send a Medicare claim online, over the phone or using any other method. However, you may use online and telephone services if you need assistance submitting a claim by mail. When you have a Medicare claim to make, start by filling out a form called the Patient’s Request for Medical Payment. This is a generic form that is used for many types of claims, so it is important to complete it carefully and attach any necessary documents and information relating to the Medicare claim and your specific needs. In most cases, you will need a medical bill and letter explaining your claim. The address you send your claim to varies based on the type of Medicare service you are requesting.

Remember, it is usually not necessary to file claims for Medicare Part C or D, as private insurance companies in Pennsylvania provide these. A PA Medicare claim should typically only be submitted if you have Original Medicare.

How to Check Medicare Claim Status in Pennsylvania

You can check Pennsylvania Medicare claims online after your form is sent in. In most cases, the status of your Medicare claim will show up online shortly after it is processed. It is also possible to review your claims by looking at your Medicare Summary Notice, which arrives in the mail periodically. If your request has been processed, then it will show up on the notice. Note that if you made a PA Medicare claim for Part C or Part D coverage, you have to contact your insurance provider for a status update. These claims usually will not show up online or in a Medicare Summary Notice. Learn more about checking your claims by downloading our comprehensive Pennsylvania health care guide.

Differences Between Pennsylvania Medicare Claims and Appeals

Making a Medicare claim in Pennsylvania is just one way to request that your service is reviewed. In addition to claims for Medicare, you can also make an appeal or a complaint. The type of request you submit depends on what type of help you need.

  • For Medicare billing or coverage issues, you should always submit a claim.
  • If you disagree with a decision Medicare made, then it is necessary to file an appeal.
  • When you are dissatisfied with Medicare services, file a complaint.

While a Medicare claim in PA is filed when you think a certain type of service needs to be covered, an appeal is submitted after Medicare has made a decision. Being turned down after filing a Medicare claim forms in Pennsylvania is a common time to send in an appeal. You can learn how to file an appeal with Medicare by reviewing the information on your summary notice. Complaints, on the other hand, should be made when you receive poor customer service or your medical care is substandard.

What Health Services Are Available in Pennsylvania?

From Obamacare health insurance plans to Medicaid and Medicare, there are various types of health coverage available in Pennsylvania. Each type of insurance can be accessed through a different application method. To learn about the easiest ways to apply for affordable health care in GA, download our comprehensive guide on health services.

Who Is Eligible for Affordable Health Services in Pennsylvania?

Affordable and free health services are often limited to Pennsylvania residents who meet all established eligibility requirements. Income, age and household size are often key factors taken into consideration when determining an applicant’s qualifications. Discover if you qualify for free or reduced-cost health insurance by reviewing the in-depth information on all program eligibility requirements within our comprehensive guide.