Medicare billing questions and answers

Medicare billing questions and answers

At your clinic, you will need to sign one form that will be kept in your patient record. This form should cover all clinic visits.

If you are hospitalized or receive hospital services (outpatient procedures, etc.), you will be asked to sign a Medicare authorization form, even if you have been to one of our clinics and already completed a form.

If you have given us information about your additional health insurance, we will bill that insurance company after Medicare has made its payment.

In general, Part A covers:

  • Hospital care (Facility Services)
  • Skilled nursing facility care
  • Nursing home care (as long as custodial care isn't the only care you need)
  • Hospice
  • Home health services

Part B covers things like:

  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health Physician Services
  • Inpatient Physician Services
  • Outpatient Services
  • Partial hospitalization (Observation Care)

Medicare doesn't cover everything. Some of the items and services that Medicare doesn't cover include:

  • Most dental care
  • Eye examinations related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care
"Self-administered drugs" are drugs you would normally take on your own. Medicare Part B generally doesn't pay for self-administered drugs. If you get self-administered drugs that aren't covered by Medicare Part B, the hospital may bill you for the drugs. However, if you are enrolled in a Medicare drug plan (Part D), these drugs may be covered. You will need to contact the Medicare drug plan (Part D) to obtain information on reimbursement.

If you receive Medicare-covered services, a Medicare Summary Notice (MSN) will be mailed to you every three months.

A Medicare Summary Notice is not a bill. An MSN details the services and supplies you received, how much Medicare will pay, and how much you need to pay the provider.

For more information on Medicare Summary Notices (MSNs), visit medicare.gov.

  • If you are a Minnesota resident and have Medicare Part A coverage, call (toll free) 1-800-330-5935.
  • If you are a Minnesota resident and have Medicare Part B coverage, call your state Medicare intermediary.
  • If you are a resident of another state, call your state Medicare intermediary.

For more information, visit the United States government's official site for Medicare members.

By phone: Call Patient Financial Services at Patient Financial Services at 612-262-9000, Monday through Thursday, 8 a.m. to 4:30 p.m. and Friday 9:00 a.m. to 4:30 p.m.

In person: Contact Patient Financial Services to find a location where a representative is available to meet with you in person.

By Email: Contact.Center@Allina.com

By mail:
Allina Health
PO Box 43
Mail Route 10209
Minneapolis, MN 55440

As a Medicare patient, you will only be responsible for uncovered charges, co-payments and deductible amounts. These amounts may vary depending on your Medicare coverage.

We do not know what your payment may be until we receive the notification from Medicare. Once Medicare lets us know what your responsibility is, we will bill your Medicare supplemental insurance company for the balance. If you do not have supplemental coverage, you will be billed for the balance.

Please bring your photo ID, insurance card and copay with you to each visit.

Yes. Once you receive your new Medicare card, please bring it with you at next appointment. As always, your Medicare Beneficiary Identification number is kept secure and confidential.

A deductible is the amount of a claim each policy holder agrees to pay annually for medical care. To learn your specific deductible, contact your insurance provider.

Your insurance company may or may not cover services provided at Allina Health. We accept most major insurance plans. Please contact your insurance company for benefit-specific questions and to see if your insurance is accepted at Allina Health.

Your insurance company can tell you if you need a referral, if you need to pay a deductible or if you have any other restrictions.

By phone: Call Patient Financial Services at Patient Financial Services at 612-262-9000, Monday through Thursday, 8 a.m. to 4:30 p.m. and Friday 9:00 a.m. to 4:30 p.m.

In person: Contact Patient Financial Services to find a location where a representative is available to meet with you in person.

By Email: Contact.Center@Allina.com

By mail:
Allina Health
PO Box 43
Mail Route 10209
Minneapolis, MN 55440

Yes. You may call our Price Estimate line at 612-262-4930. Allina will provide a good faith estimate of payment we expect to receive from you or your health plan for medical care. In order to provide you with an estimate we will need:

  • Outpatient services please have available the five-digit CPT code(s) (Current Procedural Terminology Code) associated with your services.
  • Inpatient services, please have available the five-digit CPT code(s) and the ICD9 Diagnosis code(s).
  • If you do not know the specific code(s) please contact the physician's office who has ordered the services, or will be performing the procedure.

Every insurance plan provides different benefits and may not fully cover your visit. If you feel there is a billing error, first compare your billing statement with the "Explanation of Benefits" your insurance company provided. If they match, you owe the amount on your bill. If the amounts do not match, call Patient Financial Services at 612-262-9000, Monday through Thursday, 8 a.m. to 4:30 p.m. and Friday 9:00 a.m. to 4:30 p.m.

If you feel your insurance company has denied a charge in error or processed your charge incorrectly, please contact the customer service telephone number on the back of your insurance card.

Some insurance plans do not cover physical exams or preventive visits. Contact your insurance company to see if physical examinations or preventive visits are covered.

If other medical conditions were addressed during your exam that required more evaluation, you may be billed for that service. Insurance carriers require accurate reporting from doctors when preventive care and additional problems are addressed during the same visit. So while you may be taking care of two health care concerns at one time, your insurer may see it as taking care of two office visits in one and assess your benefits accordingly.

Below are services that are usually considered part of an annual physical:

  • review of your complete medical history, including allergies, drug reactions and immunizations
  • physical exam, including a pelvic exam for women
  • medication review
  • weight, height, blood pressure and pulse

Your health care provider may ask about your tobacco and alcohol use. You may also discuss health topics like weight control and exercise.

Your health provider may recommend additional services based on your age and gender. An adult health maintenance exam may also involve lab tests, medical imaging and/or shots. Please check with your insurance provider about coverage for these extra services.

You may have other issues you want to discuss. These services may not be considered part of your physical and may require an additional charge:

  • new health concerns (upset stomach, cough, warts, moles)
  • current conditions that need further evaluation and/or new treatment (unstable high blood pressure, out-of-control diabetes)

We understand it can be confusing to receive several bills. Your hospital visit will include charges for using hospital services and charges for the doctors involved in your care. Each of these charges is billed separately.

Some hospital visits include services such as reading radiology images, analyzing laboratory specimens, consultations or providing anesthesia. These services are billed separate from the charge for staying in the hospital.

If you come to the hospital by ambulance, you also may receive a billing statement from the ambulance service.

Call the customer service telephone number on the statement you are questioning.

If you want an itemized bill or payment receipt, please call Patient Financial Services at 612-262-9000, Monday through Thursday, 8 a.m. to 4:30 p.m. and Friday 9:00 a.m. to 4:30 p.m.
Unfortunately we are not able to bill "vision plans" such as VSP as we do not contract with vision plans and we do not have the electronic capability to bill them. We can mail you an Itemized Statement and you can submit that to your Vision Carrier for reimbursement. The Itemized statement will show all the information, including the Procedure Codes, that your vision insurance requires to process a claim.
A hospital-based clinic utilizes hospital -owned facilities and resources. As such, the billing structure is different than that for services performed by a physician who operates out of a clinic setting because some of the cost of that physician's practice lies with the hospital. The hospital bills the facility fee for the use of the facility and the related practice expense. A separate fee is billed for the professional services, which is the physician's charge for the services that he or she provided.
Allina retains no information about your specific plan provisions. We are not able to speculate on whether or not a provider is in or out of network. Your insurance company retains all of your benefit information and should be able to help you with that. The phone number to reach your insurance company is usually listed on the back of your insurance ID card.