Original Medicare

Help with the four pieces of paper Medicare sends you, in the order they arrive.

Coverage rules and rates on this page are for Original Medicare (Fee-for-Service), the red, white and blue card. Have a plan from an insurance company? Go to the Medicare Advantage page.

Not affiliated with or endorsed by any government agency. Medterpret drafts letters and tracks deadlines. You sign and file.

I have a test, scan or procedure coming up.
Precheck the order: is it covered, and what Medicare pays. If the diagnosis codes don’t match, double-check with your doctor before you go, and avoid an ABN. Labs today; imaging and procedures as the engine expands.
Precheck the order
I was asked to sign an ABN.
What the notice means and your three options. The price comparison shows whether the markup is unreasonable. If it is, ask for a lower price. If the lab won’t come close, use Find a lab for one that will.
Medical-necessity denial, no valid ABN: nothing owed.
If Medicare denied the test as not reasonable and necessary (your Medicare Summary Notice may say “The information provided does not support the need for this service or item”) and the provider never had you sign a valid ABN, the provider may not bill you for it. Social Security Act §1879; 42 CFR §411.404.
This does not apply to services Medicare never covers, such as a routine physical checkup (Social Security Act §1862(a)(7)). You owe those even without an ABN.
Your ABN rights →
See your ABN options
Medicare denied the claim.
Appeal a denial: redetermination within 120 days, then the QIC. Upload the MSN, get a draft appeal letter tailored to why you were denied. Review, edit, sign and send.
Appeal a denial
Not affiliated with or endorsed by any government agency. Medterpret drafts letters and tracks deadlines. You sign and file.
Appealing a skilled-nursing discharge? →
The bill is more than Medicare’s rate.
Use Medicare’s rate as your number and negotiate with the provider. GougeStop, a Medterpret tool, helps with that.
Check the bill with GougeStop
GougeStop, a Medterpret tool.
Watch my claims for me.
Future product
Claim monitoring: we watch your Medicare claims as they post, flag new denials and prefill the appeal. Membership.
Learn more

Not affiliated with or endorsed by any government agency. Medterpret drafts letters and tracks deadlines. You sign and file.

How it works, by document

Which document do you have?
	Test orderbefore the visit	ABNAdvance Beneficiary NoticeOriginal Medicare only	Denial letterMSN, EOB or plan letter	Billafter the visit
1 · Show us	Snap a picture of the order.	Snap a picture of the ABN.	Snap a picture of the letter.	Snap a picture of the bill.
2 · See what it says	Whether the diagnosis codes match Medicare’s coverage rules for each test.	What Medicare pays for those tests, and how large the lab’s markup is.	What your plan says about why, the deadline to act, and whether Medterpret thinks it’s worth acting on. All in plain English.	Their price against Medicare’s rate, and the gap you can use.
3 · Take the next step	If the codes don’t match, double-check with your doctor before you go.	Ask for a lower price. If the lab won’t come close, use Find a lab for one that will. Medical-necessity denial, no valid ABN: nothing owed. If Medicare denied the test as not reasonable and necessary (your Medicare Summary Notice may say “The information provided does not support the need for this service or item”) and the provider never had you sign a valid ABN, the provider may not bill you for it. Social Security Act §1879; 42 CFR §411.404. This does not apply to services Medicare never covers, such as a routine physical checkup (Social Security Act §1862(a)(7)). You owe those even without an ABN.	If it’s worth it and you want our help, we draft an appeal letter tailored to the reasons you were denied. You review, edit, sign and send.	Use Medicare’s rate and our negotiating tools to get a better deal. (GougeStop)

Which document do you have?

Test order

before the visit

1 · Show us: Snap a picture of the order.
2 · See what it says: Whether the diagnosis codes match Medicare’s coverage rules for each test.
3 · Take the next step: If the codes don’t match, double-check with your doctor before you go.

ABN

Advance Beneficiary Notice

Original Medicare only

1 · Show us: Snap a picture of the ABN.
2 · See what it says: What Medicare pays for those tests, and how large the lab’s markup is.
3 · Take the next step: Ask for a lower price. If the lab won’t come close, use Find a lab for one that will.
Medical-necessity denial, no valid ABN: nothing owed.
If Medicare denied the test as not reasonable and necessary (your Medicare Summary Notice may say “The information provided does not support the need for this service or item”) and the provider never had you sign a valid ABN, the provider may not bill you for it. Social Security Act §1879; 42 CFR §411.404.
This does not apply to services Medicare never covers, such as a routine physical checkup (Social Security Act §1862(a)(7)). You owe those even without an ABN.

Denial letter

MSN, EOB or plan letter

1 · Show us: Snap a picture of the letter.
2 · See what it says: What your plan says about why, the deadline to act, and whether Medterpret thinks it’s worth acting on. All in plain English.
3 · Take the next step: If it’s worth it and you want our help, we draft an appeal letter tailored to the reasons you were denied. You review, edit, sign and send.

Bill

after the visit

1 · Show us: Snap a picture of the bill.
2 · See what it says: Their price against Medicare’s rate, and the gap you can use.
3 · Take the next step: Use Medicare’s rate and our negotiating tools to get a better deal. (GougeStop)

I have a test, scan or procedure coming up.

I was asked to sign an ABN.

Medicare denied the claim.

The bill is more than Medicare’s rate.

Watch my claims for me.

How it works, by document

Tools