Medicare can be a tricky thing. It comes with a bureaucracy that can seem nearly impregnable, too. So what happens when Medicare denies a beneficiary’s claim for care?
Claim denial is a pretty sticky situation, whether you are in Overland Park or elsewhere.
When you cannot navigate your way through a change of care or providers, or if you have been stuck with a bill that truly ought to have been covered, you can appeal.
ElderLawAnswers recently updated its handy guide that was updated not too long ago, providing an answer to the question “Can You Appeal If Medicare Refuses to Cover Care You Received?”
Essentially there is Medicare review process. Through this process the federal government works with the intermediaries involved to sort out the problem (e.g., it could be as simple a billing code error). If no relief is obtained, then the matter can be brought to court if the amount in question exceeds $1,000 to $2,000 (yes, the amount varies depending on the claim itself).
While no one relishes a trip to the courthouse, you can either represent yourself, be represented by a personal representative, or even be represented by your own attorney.
A helpful statistic: “The Medicare Rights Center estimates that only about 2 percent of Medicare beneficiaries appeal denials of care, but 80 percent of those who appeal Part A denials and 92 percent who appeal Part B denials win more care.”
Remember: “An ounce of prevention is worth a pound of cure.” When making your financial, tax and estate plans, do not go it alone. Be sure to engage competent professional counsel.
For more information about estate planning in Overland Park, KS (and throughout the rest of Kansas and Missouri) and to download free tools to help you organize your estate, visit my estate planning website.
Reference: Elder Law Answers (mod. December 19, 2013) “Can You Appeal If Medicare Refuses to Cover Care You Received?”