George, a longtime client, had called us in a bit of a panic about what to do. We asked him to be a bit more specific, so we could determine how best to help.

“I had a heart attack and the pulmonary doctor has indicated that I might need triple bypass heart surgery!” He was obviously alarmed, in an excited state, and was worried all at the same time.

“George, take a deep breath and tell me how I can help,” I requested as calmly as possible. I was concerned that he might have a heart attack while we were simply trying to answer his question over the phone. “I want to know what my options are for where to go for my heart bypass surgery if I have to have it!” he exclaimed, still somewhat loudly.“Well, where do you want to go?” I asked in a way to continue to calm him down.

“Can I go to the Houston Heart Center for my surgery if I want to?” he inquired.

“Of course, you can.” We double-checked what Medicare coverage plan he had and found that he was on a Medigap plan to go with his Medicare A&B.“Any doctor, any hospital, anywhere in the USA,” we explained to remind him of what coverage he had selected a few years before.

George, you must remember that Medicare is your health coverage. Medicare gets the bill, processes the claim, and pays its portion of the bill. Medicare then sends an electronic message to your Medigap carrier and the Medigap (supplement) carrier has one job, pay the balance of the bill as instructed by Medicare.“What if the doctor doesn’t take Medicare?” he inquired.

Ultimately, you are responsible to pay the provider (doctor or hospital) in a situation where the provider does not participate in Medicare. That just means that you, as the recipient of the services, must send the bill to Medicare. Medicare will still process the claim and pay its portion, then will bill your Medigap for the unpaid portion, and the Medigap still pays the difference. In other words, when you pay the bill, you file the claim with Medicare. Medicare will send you a check and the Medigap will send you a check and you get reimbursed. If the doctor’s office files the paperwork, the checks go to the doctor. When you file, the checks come to you.

Over 90% of providers participate in Medicare, so in most cases, the doctor’s office will handle the billing paperwork. So, it’s rare that members must submit a bill to Medicare themselves. There is a claim form available at
Just enter medical claim form in the search box, or click on the forms section of options.