Medicare processed 906 billion outpatient insurance claims in 2010 - and refused to pay 10 percent of them. But if you're a senior on Medicare with a denied claim, your odds of turning that around are surprisingly good if you appeal.
Few things are more frustrating than battling bureaucracy. But if you’ve had a Medicare claim denied – and about 10 percent of Medicare claims are denied – you’re well-advised to hang in there and fight the good fight!
Reuters recently published an article explaining “How to appeal when Medicare won't pay.” It is not an uncomplicated process, but if Medicare refuses to pay for services your doctor recommends it’s certainly worth your while to fight. The numbers are fairly enlightening:
In 2010, 40 percent of Part A appeals and 53 percent of Part B appeals were granted, according to the Centers for Medicare & Medicaid Services, which administers Medicare (CMS). Even in the case of big ticket durable medical equipment appeals, 44 percent of appeals were successful. More than half of appeals to Medicare Advantage and prescription drug plans are successful, too.
Medicare consumer advocates offer these tips for filing an appeal:
- Send a letter. Your paper trail starts with the summary notice of coverage you get in the mail. Take this notice, circle the erroneous denial, and write out why you think it should be covered. Make a copy, and mail one.
- Don’t waste time. You have 120 days to file an appeal for Medicare Part B claims, and only 60 days for Medicare Advantage or Part D. If you filed for pre-approval and were denied, you have only 14 days to initiate your appeal.
- Be persistent. You have a right to four levels of appeal, so don’t quit until you have exhausted all of your options.
- Get help. For appeals beyond the first level, you may want to seek help from an elder law attorney.
Reference: Reuters (November 13, 2012) “How to appeal when Medicare won't pay”