Below is a sample Medicare Summary Notice (MSN) for Part B services and information on how to read it. The MSN is not a bill. Do not send money to Medicare or to the provider until you get a bill.
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Date (1): Date MSN was sent.
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Customer Service Information (2): Who to contact with questions about
the MSN. Provide your Medicare number (3), the date of the MSN (1), and the date
of the service you have a question about (9).
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Medicare Number (3): The number on your Medicare card.
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Name and Address (4): If incorrect, contact the company listed in (2),
and the Social Security Administration immediately.
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Be Informed (5): Messages about ways to protect yourself and Medicare
from fraud and abuse.
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Part B Medical Insurance - Assigned Claims (6): Type of service. See
the back of MSN for information about assignment. (Please Note:
For unassigned services, this section is called "Part B Medical
Insurance - Unassigned Claims.")
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Claim Number (7): Number that identifies this specific claim.
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Provider's Name and Address (8): Doctor (may show clinic, group,
and/or referring doctor) or provider's name and billing address. The referring
doctor's name may also be shown if the service was ordered or referred by
another doctor. The address shown is the billing address, which may be different
from where you received the services.
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Dates of Service (9): Date service or supply was received. You may use
these dates to compare with the dates shown on the bill you receive from your
doctor.
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Amount Charged (10): Amount the provider billed Medicare.
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Medicare Approved (11): Amount Medicare approves for this service or
supply.
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Medicare Paid Provider (12): Amount Medicare paid to the provider. (Please
Note: For unassigned services, this column is called "Medicare
Paid You.")
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You May Be Billed (13): The total amount the provider may bill you,
including deductibles, coinsurance, and non-covered charges. Medicare supplement
(Medigap) policies may pay all or part of this amount.
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See Notes Section (14): If letter appears, refer to (16) for
explanation.
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This is not a bill (15): This is not a bill.
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Notes Section (16): Explains letters in (14) for more detailed
information about your claim.
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Deductible Information (17): How much of your yearly deductible you
have met.
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General Information (18): Important Medicare news and information.
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Appeals Information (19): How and when to request an appeal.