Medicare Claim Rejected? Fight Back!

Believe it or not, the odds are not stacked against you. Many families appeal – and win.

In my experience, I’ve seen far too many people taking a defeatist attitude when a claim is rejected…and paying thousands of dollars out of their own pockets. And my advice to my clients is always the same: You’re not licked yet!

You can appeal a rejection. And – quite often – you can win. In fact, in certain categories – such as rejections of payments for doctor visits and services covered under Part B – 53% of those who appeal actually won.

Knowing how to appeal, of course, is the key…because appeal procedures vary widely, among original fee-for-service Medicare, a Medicare Advantage plan from a private insurance company, and a Part D prescription-drug plan.

Federally-subsidized Advantage plans are similar to health-maintenance or preferred-provider organizations. If you’re planning to appeal a rejection by one of these, or by a Medicare Part D prescription drug plan, the Centers for Medicare & Medicaid Services has a helpful brochure called “Medicare Appeals.”

If you need help appealing a hospital discharge, or appealing claims under original Medicare, Medicare Advantage, a good resource is www.medicareinteractive.org.

If you have original Medicare, and you want to appeal an end-of-care decision by a home health agency, skilled-nursing facility, hospice agency, or outpatient rehabilitation facility, try the Center for Medicare Advocacy, which publishes booklets on the appeals process.

And if at first you don’t succeed…try, try again. In most cases, appeals can be heard up to five times!

You also may want to consider using an attorney or advocate, along with going to organizations like the Medicare Rights Center, the State Health Insurance Assistance Program, and the National Association of Healthcare Advocacy Consultants (nahac.com).

Let’s face it…trying to find answers to Medicare questions usually leads only to more questions. But we can help.

At The Law Offices of Alice Reiter Feld & Associates, we’ve been practicing Elder Law in South Florida for 33 years. We’ve answered Medicare questions for thousands of families. And we’ve helped them, as well, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid and the VA.

We can answer your Medicare questions. And we’re just a phone call away.

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Posted in Alice Reiter Feld Florida Elder Law Monday Memos

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