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 him file a claim. Advise
the claimant of his claim number and tell him he must give this number to the provider.
Any bills or receipts submitted should be returned to the claimant so that he 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 his claim. If it appears he 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 his 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 his own or has a competent person
helping him, send a CMS 1490S and a handbook if it appears he does 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 his 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 his 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 him.
No control is necessary.