[The unfortunate case of Mr. Back and his case against Medicare] makes it clear that beneficiaries have the right to challenge a hospice provider’s refusal to provide a service that a doctor deems necessary, Mr. Deford said. But it’s disappointing because it doesn’t ensure that people receive a notice of their right to appeal when they enter hospice care, or that any mechanism exists for expedited appeals – an important protection for people who are dying.
Medicare, and really any kind of health program from private insurance to public entitlement, is always disappointing when it fails patients due to bureaucratic dead ends. It’s even worse when the patient is a hospice patient.
Much can be learned through the unfortunate case of Howard and Emily Back. Emily, now deceased, was a California hospice patient covered by Medicare. Howard appealed his wife’s lack of treatment through the court process. However, the court was quick to point out that there is an administrative appeals process through Medicare regarding its hospice care decisions.
The entire case is detailed in a recent post in The New Old Age a blog through the New York Times, titled “Court: You Can Appeal Medicare Decisions About Hospice Services.” As this blog post notes, Emily was denied coverage for a pain medication while in hospice and in the last stages of life. Consequently, Howard paid for them out of pocket and later (after Emily’s passing) appealed to Medicare to cover the expenses for doctor-ordered medication. While initially told there was no such Medicare appeals process and was turned away, Howard learned otherwise.
As Howard sought to set a precedent so future couples would not face the same roadblocks, the court has finally found and verified that a Medicare appeals process exists. In fact, one can appeal a Medicare decision regarding hospice services with a form labeled “CMS-1490S,” if the beneficiary believes they have been inappropriately denied services.
This case is illustrative of the inherent problems that can occur when the competing interests of patient care and governmental bureaucracy collide.
Reference: The New Old Age blog of The New York Times (September 7, 2012) “Court: You Can Appeal Medicare Decisions About Hospice Services”