What to Do When a Doctor Bills Someone With QMB
A QMB member generally does not owe Medicare Part A or Part B deductibles, coinsurance, or copayments for Medicare-covered care.
Start here
Compare the bill with the Medicare Summary Notice or plan Explanation of Benefits, then call the provider’s billing office and state that the patient was enrolled in QMB on the date of service. Ask the office to stop billing, correct its records, recall any collection account, and refund any prohibited Medicare cost-sharing already paid.
What to have in front of you
- The provider bill and account number
- Medicare Summary Notice or Medicare Advantage Explanation of Benefits
- Proof or notice showing QMB coverage and effective dates
- Dates, names, and notes from billing-office calls
- Any collection letter, payment receipt, or credit-report entry
What to say when someone answers
“The patient was enrolled in the Qualified Medicare Beneficiary program on the date of service. Federal QMB protections prohibit billing them for Medicare Part A or Part B cost-sharing on Medicare-covered services. Please correct the account, stop collection, and send written confirmation.”
Small but useful: Write down the person’s name, the date, the exact next step, and when you should call again.
Do this in order
- 1
Verify the charge is Medicare Part A or Part B cost-sharing for a Medicare-covered item—not a noncovered service, Part D drug charge, or permitted Medicaid copayment.
- 2
Call the provider’s billing supervisor and give the QMB effective date. Do not send an original eligibility notice.
- 3
If billing continues, call 1-800-MEDICARE with the provider name, service date, bill, and call notes. Medicare can contact the provider.
- 4
Dispute a collection account in writing and include proof that the amount is not owed. Keep copies and delivery confirmation.
What happens next
Medicare providers and suppliers, including Medicare Advantage providers, may not bill QMB members for prohibited Medicare cost-sharing. CMS says providers must refund improper payments. The office may need to rebill or adjust its internal records.
If the first answer doesn’t solve it
Ask Medicare for the complaint or case reference and the next follow-up date. If a debt collector is involved, tell Medicare and respond to the collector’s validation notice by the deadline; free SHINE counseling can help organize the record.
Official sources
Checked August 4, 2026. Programs, hours, funding, and waitlists can change. Confirm details directly before relying on them.