Medicare.gov - Medicare.gov - How to Get Personal Information Over the Phone

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How to Get Personal Information Over the Telephone

Note: If you can't provide the correct information, the Customer Service Representative won't provide any entitlement or claim information, or answer any questions about your or someone else's records over the telephone. Personal information is protected under the Privacy Act and the HIPAA Privacy Rule. It is for the protection of the person with Medicare that the CSR won't provide the information over the telephone.

If you are:

You will need to provide:

Then the Customer Service Representative (CSR) will give you:

1. A person with Medicare

Your

Full name;
Date of birth;
Medicare number; and
One additional piece of information such as Social Security Number, address, phone number, effective date(s), whether you have Part A and/or Part B Medicare coverage.

Any entitlement and claim information, and answer any questions about your Medicare coverage.

2. The parent of a minor child

Note: Generally, a parent may have access to the child's information as his/her personal representative as long as this follows State or other law.

The parent is no longer the personal representative of the child when the child reaches the age of majority or becomes emancipated, unless the child chooses to have the parent continue as a personal representative.

The minor child's

Full name;
Date of birth;
Medicare number; and
One additional piece of information such as Social Security Number, address, phone number, effective date(s), whether you have Part A and/or Part B Medicare coverage.

Any entitlement and claim information, and answer any questions about a specific issue.

3. The Social Security Administration Appointed Representative, or A legal guardian of any person with Medicare who has been declared incompetent by the court

Note: To have any questions answered over the telephone, the CSR must have proof that you are the representative or legal guardian, or your name must appear on the CSR's official records.

Your name and the person with Medicare's

Full name;
Date of birth;
Medicare number; and
One additional piece of information such as Social Security Number, address, phone number, effective date(s), whether you have Part A and/or Part B Medicare coverage.

Any entitlement and claim information, and answer any questions about a specific issue.

4. The legal representative as defined by the State

Note: To have any questions answered over the telephone, the CSR must have proof that you are the legal representative, or your name must appear on the CSR's official records.

Your name and the person with Medicare's

Full name;
Date of birth;
Medicare number; and
One additional piece of information such as Social Security Number, address, phone number, effective date(s), whether you have Part A and/or Part B Medicare coverage.

Information about the issue for which you are allowed to get as the legal representative.

5. A person with Medicare's spouse, relative, friend, or advocacy group member or volunteer

Note: The CSR must have a written approval on file that allows you to get specific information, or the person with Medicare must give verbal approval for the CSR to speak with you.

If the person with Medicare provides a verbal approval, it is good for 14 days. If you need to get information after 14 days, the person with Medicare should send in a written approval.

The person with Medicare's

Full name;
Date of birth;
Medicare number; and
One additional piece of information such as Social Security Number, address, phone number, effective date(s), whether you have Part A and/or Part B Medicare coverage.

Any entitlement and claim information, and answer any questions about a specific issue allowed by the approval.

6. A person with Medicare's spouse, relative, friend, or advocacy group member or volunteer and

there is no written approval on file, and

the beneficiary isn't available to verbally approve the CSR to speak with you.

No claim information and won't answer any questions about the person with Medicare.

7. A person with Medicare's spouse, relative, friend, or advocacy group member or volunteer asking for information on a specific claim and

you don't have a copy of the Medicare Summary Notice in hand,

there is no written approval on file, and

the person with Medicare isn't available to verbally approve the CSR to speak with you.

The person with Medicare's

Full name;
Date of birth;
Medicare number; and
Information on the specific claim (for example, date of service, physician name, or procedure)

Only information:

On whether or not the claim has been received or processed, and
The date the person with Medicare can expect to receive the Medicare Summary Notice.

8. A person with Medicare's spouse, relative, friend, or advocacy group member or volunteer asking for information on a specific claim and

you have a copy of the Medicare Summary Notice in hand,

there is no written approval on file, and

the person with Medicare isn't available to verbally approve the CSR to speak with you.

The person with Medicare's

Full name;
Date of birth;
Medicare number; and
Information on the copy of the Medicare Summary Notice

Only information about the service(s) that appears on the Medicare Summary Notice.

9. A person with Medicare's spouse, relative, friend, or advocacy group member or volunteer who states that the person with Medicare is deceased.

The person with Medicare's

Full name;
Date of birth;
Medicare number; and
One additional piece of information such as Social Security Number, address, phone number, effective date(s), whether he/she has Part A and/or Part B Medicare coverage.

Note: The CSR needs this information to access the person with Medicare's record to see if a Proof of Death is on file.

If Proof of death is not on file, the CSR will tell you to call Social Security to let them know the person with Medicare is deceased. The Social Security Administration telephone number (1-800-772-1213).

The CSR won't provide any claim information or answer any questions about the deceased individual. Instead, the CSR will tell you that your request must be in writing and include the authority under which you are making the request (e.g., executor, next of kin). You also must state why you need the information. However, the CSR may answer questions about information on a specific claim.

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