HI 00630.140 Handling Inquiries Relating to Medicare - General

Some inquiries are received from beneficiaries entitled to HI or SMI either asking for payment of HI and/or SMI or asking how to go about filing their claims. In some cases, the beneficiaries have received only uncovered hospital and/or medical services furnished outside the United States. In other cases, the beneficiaries have received hospital and/or medical services in the United States. Requests are also received asking for information about technical provisions relating to Medicare coverage and payments.

The Medicare handbook is designed to answer most questions a beneficiary might have about coverage and payments. However, some entitled foreign beneficiaries are not sent either a handbook or an HI card. Beneficiaries outside the U.S., automatically entitled to HI at age 65, are not sent a handbook or HI card unless they also enroll in the SMI program. (However, because of errors in OCRO processing, HI cards have been sent to some individuals outside the U.S. entitled only to hospital insurance.) Some individuals may lose their handbook, and others because of advanced age, sickness, or illiteracy, may not be able to file a claim without assistance.

All inquiries relating to Medicare coverage will be handled by the module CIS clerk (unless some other action is necessary in the module or CDB). The Medicare handbook and the POMS will be the primary references for answering inquiries about how to file a claim. Requests for payment or assistance in filing will be handled under the following instructions.