If only HI is involved, advise the claimant to contact the provider; i.e., hospital, extended
care facility, or Home Health Agency, which furnished the services. The provider will
advise the claimant whether the services were covered and help them file a claim.
Advise the claimant of their claim number and tell them they must give this number
to the provider. Any bills or receipts submitted should be returned to the claimant
so that they can forward them to the provider.
If an HI card was not issued to the claimant, institute procedures to have one issued
whether or not the claimant has asked for a card. The reply to the claimant should
not be delayed pending receipt of the card since the claim number is all the provider
needs to know.
Where SMI is involved examine the file to see whether or not it appears the claimant will need
assistance in filing their claim. If it appears they will, request the appropriate
Foreign Service post to provide it. The originals of any bills or receipts submitted
by the claimant should be enclosed with the request to the FSP or VARO after making
copies for the folder. A copy of the Medicare handbook and Form CMS 1490S, Request
for Medicare Payment, should also be enclosed with the request to the FSP. The FSP
should be asked to help the claimant complete and mail the CMS 1490S. Advise the FSP
that the instructions for completion are found on the back of the form and the name
and address of the carrier handling medical insurance claims for the area in which
the services were furnished can be found in the handbook. If HIB is also involved,
advise the FSP that the claimant must write to the provider about their hospital insurance
claim and that only those bills and receipts having to do with medical insurance should
be sent to the medical insurance carrier. Any bills or receipts having to do with
hospital insurance should be sent to the provider.
Where it appears the claimant can follow through on their own or has a competent person
helping them, send a CMS 1490S and a handbook if it appears they do not have one.
(All inquiries received from the Philippines should be referred to VARO.) Advise the
claimant to complete the form according to the instructions on the back of the form
being sure to show their claim number on the form and on each bill. If the proper
carrier can be determined, give the claimant the name and address. Otherwise, refer
the claimant to the appropriate pages of the handbook. Supply any technical advice
that seems appropriate. If HI is also involved, advise the claimant to write to the
provider about their hospital insurance claim and that only those bills and receipts
having to do with medical insurance should be sent to the medical insurance carrier.
After photocopying, the originals of any bills or receipts submitted by the claimant
should be returned to them.
No control is necessary.