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What to do when you are denied Medicare

What to do when you are denied Medicare

There can be times when a patient may be denied Medicare coverage, or they might simply refuse to pay for a specific treatment. Understanding what to do when you are denied Medicare is important in order to appeal and give assistance for your medical treatment.

Medicare will send the patient with a denial letter which would state that they are not willing to pay for a treatment that the patient requires. If a patient does receive a denial letter it is extremely important to take action right away rather than wait on it. Here are a few steps that can be taken if you are denied Medicare.


Step 1: Appealing a Denial

If a patient thinks that the choice of Medicare for denying coverage for a treatment is wrong, they can always challenge their decision. This process is commonly known as “appealing a denial”. If a patient does appeal for a denial there is a highly likely chance that Medicare just might take back its denial and either pay for some part of the treatment or even for all of it. A patient is able to appeal when

– Medicare denies to pay to any kind of medical health care services, prescriptions or supplies that a patient may need during or after their treatment

– Medicare denies to pay any kind of bill that is related to health care services, prescription or supplies that a patient might already have

– Medicare denies to pay for any kind of medication a patient may need

– Medicare denies paying for any kind of services that a patient still might require

It is important to keep in mind that every appeal has a deadline, therefore it is extremely important to appeal before the deadline ends. It is always mentioned on a denial notice how much time a patient has to appeal a denial and it is recommended that patients should always ask the help of their doctor when appealing in such circumstances.


Step 2: Always check the fine print of the Medicare Policy

Whenever a patient receives a denial, the denial letter is often delivered in an Explanation of Benefits. This letter outlines what is being billed to the patient, how much Medicare is paying for it and how much and why it isn’t.

Once it has been cleared why Medicare has decided to deny coverage for a patient it is important to go through the policy just to confirm what other options there might be for the patient.


Step 3: Get in contact with Medicare billing office

If a treatment is covered by Medicare and a patient is still denied coverage, it is advisable to get in touch with Medicare billing department which is a much easier option rather than waiting on hold for a Medicare customer service representative. This way a patient may be able to find out the exact reason why they have been denied coverage and what options they might have to get financial assistance for their treatment.

However, it should be kept in mind that if the policy clearly states that the services needed are not covered by Medicare then the billing office will also not be able to provide assistance.


Step 4: Look for other options for medical financial assistance

If even after an appeal Medicare still denies medical coverage to the patient, then it is time to look for other financial assistance options that might be available to them. A patient may easily find lots of different financial assistance programs both run by the government or privately that would be willing to financially assist an individual during their treatment.

A patient may either look for options within their own community or even online if there is no option for the treatment within their own neighborhood. Fundraising online has been an effective way for many patients to receive proper medical care and treatment. This works through creating a fundraiser and sharing the fundraising page with friends and family online or word of mouth.


References:

1. Medicare Denials: http://www.masslegalhelp.org/health/medicare-denials

2. 5 steps to take your health insurance claim denied: http://www.moneytalksnews.com/5-steps-take-your-health-insurance-claim-denied/