Initial Beneficiary Notices

140.6.1 - Initial Beneficiary Notices (Rev. 1186, Issued: 02-23-07; Effective: 01-01-06; Implementation: 05-23-07) Notice 1 - Full Denial If the doctor should have known that Medicare would not pay for the denied services and did not tell you in writing before providing the services, you may be entitled to a refund of any amounts you paid. However, if the doctor requests an appeal of this claim within 30 days, a refund is not required until we complete our appeal. If you paid for this service and do not hear anything about a refund within the next 30 days, contact your doctor’s office. Notice 2 - Reduction in Payment If the doctor should have known that Medicare would not pay for the more extensive service and did not tell you this in writing before providing the service, you may be entitled to a refund of any amount you paid which is more than the doctor is allowed by law to charge under Medicare for the less extensive service. However, if the doctor requests an appeal of this claim within 30 days, a refund is not required until we complete our appeal. If you paid for the more extensive service and do not hear anything about a refund within the next 30 days, contact your doctor’s office. In addition, add the following paragraph: You could have avoided paying $_______, the difference between the maximum amount the doctor or supplier is allowed to charge and the amount Medicare approved for the lesser service, if the claim had been assigned.