Medicare Frequently Asked Questions
We hope the questions and answers below will help you with everything you need to know about Medicare.
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Tuesday, Thursday, and Friday: 8 am – 5 pm
Q. Why doesn't Medicare cover all medications given in the hospital setting?
A. Medicare does not cover medications that they identify as self-administrable. Medicare states that any medication that a person receives in the hospital on an outpatient basis that they could take themselves under normal circumstances is considered self-administrable. This would be considered things like pills, tablets, etc. The patient is billed for self-administrable drug charges.
Q. Why do I have to give you information about other insurance if I have Medicare coverage?
A. In some cases such as a car accident, worksite injury, or injury on someone else’s property, Medicare requires us to bill any insurance company that could have responsibility for your expenses before we bill them. In fact, Medicare will not allow us to file claims until the other insurer has denied claims. It is Wheaton’s responsibility to make sure all claims are filed appropriately.
If Medicare is your secondary insurance plan, we are required to bill your primary insurance first. It is necessary that we have complete information about all of your insurance coverage.
Q. Do I have to sign any forms before Wheaton Franciscan can bill Medicare?
A. You will be asked to sign a Consent for Treatment form each time you receive services. You may also be asked questions each time you receive services that Medicare requires we ask.
Q. What is a Medicare Explanation of Benefits form?
A. The Explanation of Benefits form is an information document that Medicare sends to you and Wheaton Franciscan Healthcare after it has processed your medical claims. The Explanation of Benefits form provides you and us with information about the payment status of your bill.
Q. What is the difference between Part A and Part B Explanation of Benefits forms?
A. Part A covers inpatient hospitalization and Part B covers outpatient and physician services.
Q. What should I do with the Explanation of Benefits form?
A. We recommend you keep the Explanation of Benefits forms you receive from Medicare until all your medical claims have been paid in full. If you have other health insurance in addition to Medicare coverage, your insurance company requires a copy of the Explanation of Benefits before they will pay any remaining balance on your account.
Q. Should I pay the balance that is listed as "your total responsibility" on the Explanation of Benefits form?
A. No. This amount could change depending on your individual insurance coverage. You should wait until you receive a bill from Wheaton Franciscan Healthcare before making payment. If you do not receive a bill from us, please contact customer service.
Q. Will I have to pay any money for my services?
A. As a Medicare patient, you will only be responsible for non-covered charges, co-pays and deductible amounts. These amounts may vary depending on your Medicare coverage. Once Medicare lets us know the amount, you are responsible for, you will be billed for the balance if you do not have other health insurance.
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