How Your Bills Get Paid

Does The Medigap Insurance Company Pay My Doctor Or Provider Directly?

When you have a Medigap policy, the insurance company must pay your doctor or provider directly when:

• Your doctor or provider has signed an agreement with Medicare to accept assignment of all Medicare claims for all their Medicare patients, and
• You tell your doctor's office to put on the Medicare claim form that you want Medigap insurance benefits paid to the doctor or supplier. Your doctor should put your Medigap policy number and the company name on the Medicare claim form. You will need to sign the claim form or have your doctor keep your signature on record. Make sure this information is correct.

When these conditions are met, the Medicare carrier will process the claim and send it to the Medigap insurance company. A Medicare carrier is a private company that has a contract with Medicare to pay Part B bills. The carrier will send you a Medicare Summary Notice. Your Medigap insurance company will pay your doctor or provider directly and then send you a notice. If you don't get this notice, you may ask your Medigap insurance company for it.

In most cases, Medicare claims are sent directly to the insurance company, even if the doctor doesn't accept assignment on all claims.

If Your Doctor Is Not Paid Directly

If the Medigap insurance company doesn't pay your doctor directly when the above two conditions are met, you should report this to your State Insurance Department. For more information on Medigap claim filing by the carrier, call your Medicare carrier.