Wellspring Health Center

Several of our Medicare patients have been reimbursed for their visits to the office. If you are interested in trying it, this is the process they have used. The instructions to submit a claim to Medicare are very simple and very well explained in MyMedicare.gov. It is best to create an account and get the info straight from them. 1.Go to my medicare.gov create an account sign in... 2.Click on Claims and How to File a Claim 3.Follow the instructions provided. (Click on Patient Request for Medical Payment and get the Form CMS-1490S, etc.) In the following address there are lists of contacts for extra help: www.medicare.gov/people-like-me/extra-help/extra-help.html Create a document like the one below and include it in every reimbursement submission you make. Date Medicare note Dr. William Teubl, our internist/primary care doctor, (who has long been associated with the Hyde Park Family Practice center), has semi-retired to his home office in Tivoli, NY. He no longer takes any insurance, or participates with any insurance company or Medicare, and does not submit claims directly. Therefore, we ourselves are needing to address this, with Medicare & ___________________ [fill in the name of your supplementary insurance] coverage. Thank you, Name Address