Coverage involved Original Medicare Medicare Advantage Part D prescription coverage Medicare plus Medicaid, Medigap, retiree, VA, or other coverage Not sure yet
Document you are reviewing Medicare Summary Notice Explanation of Benefits Provider, hospital, supplier, or pharmacy bill Collection notice or past-due balance Estimate, good-faith estimate, or possible surprise bill
Main concern Service, supplier, or provider looks unfamiliar Amount owed is confusing or higher than expected Claim was denied or marked not covered Possible duplicate, wrong date, or wrong charge Secondary insurance or coordination problem Collection pressure or past-due threat
Bill status Not due yet Due soon Past due Already with collections May already be paid or overpaid
Statement access Have the notice or statement Missing the Medicare Summary Notice Only saw an online claim No online account or access yet
Provider billing office status Not called yet Called and waiting for review Received an explanation Dispute or correction request started
Secondary coverage No secondary coverage known Medigap or supplement Medicaid, MSP, or QMB may apply Employer, union, retiree, or other plan Not sure
Records folder status Scattered Some records gathered Organized and copied Missing key records
Outside help contacted? No outside help yet Provider, plan, Medicare, or pharmacy SHIP or Senior Medicare Patrol Legal aid, advocate, or consumer office
Caregiver helping with calls? Yes No Not sure yet
Use this to prepare a bill-review conversation without entering private claim details.
Do not enter Medicare numbers, claim numbers, account numbers, Social Security numbers, birth dates, diagnoses, full service dates, provider account IDs, passwords, or private medical records into this worksheet. Keep personal documents in a secure folder.
This organizer is educational and administrative only. It is not legal, medical, insurance, benefits, debt, tax, credit, or financial advice. Confirm personal next steps with Medicare, the plan, SHIP, Senior Medicare Patrol, the provider billing office, legal aid, or another qualified professional.
Official references:
Medicare Summary Notice ,
Medicare claim status ,
Senior Medicare Patrol statement review ,
CMS medical bill rights ,
SHIP Help locator .
