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Confusing Letters and Medicare Mail

After enrolling or changing coverage, you may receive mail from Medicare, insurance companies, doctors, pharmacies, and other organizations. Some documents are important, while others may be advertisements or duplicates.

Frank can help you understand:

• What the letter means
• Whether action is required
• What you should keep
• What may safely be discarded
• Who to contact if something appears incorrect

Medical Bill or Explanation of Benefits

An EOB means Explanation of Benefits. It explains how a claim was handled and is usually not a bill.

The normal process:

1. The provider submits the claim.
2. The billing department or medical group processes it when applicable.
3. Medicare or the insurance company reviews the claim.
4. You receive an EOB or Medicare Summary Notice.
5. The provider may later send the actual bill.

Processing times vary and may take several weeks. Compare the provider bill with the completed EOB before paying. If the amount looks wrong or the claim may still be processing, contact Frank or the provider’s billing office.

Prescription Coverage or Pharmacy Problem

Prescription problems can happen for many reasons:

• The drug is not on the formulary
• Prior authorization is required
• Quantity limits apply
• Step therapy is required
• The pharmacy is outside the plan network
• The pharmacy has incorrect insurance information
• The refill is too early
• The drug tier changed
• A generic or lower-cost alternative may be available

Frank can help check coverage, pharmacy networks, prior authorization requirements, lower-cost alternatives, and possible appeal or exception options.