My doctor didn't file my Medicare claim and I paid out of pocket. Can I file it myself?

Medicare.gov says that if you have Original Medicare, the law requires your doctor, provider or supplier to file Medicare claims for covered services and supplies [1]. If the claim has not been filed for you, contact the provider and ask them to file it. If they still have not, you can call 1-800-MEDICARE [1].

You can file your own claim in some cases. Medicare.gov says that if you paid out of pocket because your provider refused to submit a claim, you will have to submit your own [1]. You fill out the Patient Request for Medical Payment form (CMS-1490S) [1]. In general you send the completed form, the itemized bill from your provider, and a letter explaining why you are filing the claim. Add any supporting documents, like notes from your doctor [1]. Mail it to the address for your state, which is listed in the Medicare Administrative Contractor Address Table within the claim form [1].

The time limit is 12 months, or 1 full calendar year, after the date of the service, unless an exception applies. After that, Medicare won't pay its share [1]. Medicare.gov says to ask for the exact time limit. Near that limit, with no claim filed, it says to file yours [1]. The sources here do not list the exceptions or say how long payment takes.

Open the Medicare.gov Claims page and the CMS-1490S form it links to, and read the instructions on the form. Your Medicare Summary Notice or Medicare account shows whether a claim was filed - "Don't know yet" for your case.