Posts Tagged "medication denial"
June 23, 2022
Problem? Medicare Rights Center Can Fix it
He is a one-time heart surgery patient and vulnerable to COVID. She has to take her medication religiously twice a day to prevent a blood pressure spike.
During the pandemic, Mr. and Mrs. Quader of Brooklyn, New York, got a notice that the health care subsidy they had been receiving through the Medicare Savings Program for low-income retirees had been terminated.
Luckily, counselors on the Medicare Rights Center’s telephone hotline solved the couple’s problem – just like they have helped tens of thousands of retirees nationwide every year that the center’s New York City helpline has been operating.
“They knew where to go. They knew what to do,” Mrs. Quader said in one of several video testimonials posted to the Medicare Rights Center’s website. “They stood by us every time.”
She made the call to the center because she had just happened to hear about it. It turned out the Quadar’s paperwork had been lost in the system, and the couple’s counselor got the benefits restored.
The Medicare Rights Center’s services, which are free of charge, cover myriad problems retirees encounter under Medicare, such as how to appeal insurance company denials of coverage for treatments or medications. The counselors also solve unique problems like that of a 66-year-old woman named Rose. The Plant City, Florida, resident needed a replacement wheelchair but had received one she was unable to use, rendering her immobile. The center got her a chair that worked for her.
“When I sat down in that chair for the first time, it was nice and cushy,” she said in a Medicare Rights Center video. “I could finally go [outdoors] and see the light.”
Many people who call the center need help with simpler issues like enrolling in Medicare Parts A and B or sorting out their options for additional coverage. Bill’s enrollment problem was much more complicated. …Learn More
June 9, 2022
Get Help with Medicare Coverage Denials
The United States has a notoriously complex healthcare system, and Medicare is no different.
In the early months of the pandemic, the Medicare Rights Center received a large number of calls to its telephone help line from people over 65 who had suddenly been laid off and lost their employer coverage. Even when there isn’t a crisis, the center’s staff and volunteers answer all manner of questions about Medicare enrollment rules, insurance options, and what to do when an insurance company denies them coverage.
Sarah Murdoch is the center’s director of client services and oversees the helpline. She spoke with Squared Away about the common issues retirees face and how they can address them.
Question: Your helpline fielded 42,000 questions about Medicare in 2020 and 2021. How does that compare to past years?
It’s in that ballpark year to year – around 20,000 questions. But we saw, within that 42,000, a shift in the actual trends.
Throughout the pandemic, particularly in 2020 when there were lockdowns and people were getting laid off left and right, we got a lot of calls from people who unexpectedly had no income. We heard from people who had insurance through their job and that was not an option anymore. Or they were already on Medicare and were trying to figure out how to pay their costs, or they were laid off and had to figure out how to get into Medicare. That has eased up but was a big thing we saw in the beginning of the pandemic.
We also had questions related to benefits for low-income people. We told people who suddenly had zero income about the income requirements for the Medicare Savings Program, Medicaid, and the state pharmaceutical assistance programs – anything that can lessen the hardship.
In 2020 and 2021, nearly a third of the complaints on your helpline were about service denials by insurers that provide Medicare Advantage or Part D drug plans. Start with Advantage plan denials – are they a big issue for retirees?
The Medicare Advantage plans often have doctor and hospital networks, whereas original Medicare doesn’t have networks. People may be denied coverage by an Advantage plan if they have an out-of-network provider. It could also be a denial of a medical service or a prescription medication. We do see it more but it’s hard to tease that out from the fact that more people are just enrolled in Medicare Advantage.
Do Medigap supplements to Medicare have similar issues with denial of coverage?
Medigap is different – the plans are never making their own claim determinations. If something is approved by original Medicare, then Medigap is going to pay for it as long as the retiree has a Medigap plan that has that type of coverage. In the Medicare Advantage policies, however, insurers are making the claims determination. All of the insurance companies have their own claims adjusters making those decisions – as opposed to contractors who process claims for the Medigap plans on behalf of the Centers for Medicare and Medicaid Services. The Medigap insurer isn’t making any decisions as to whether something is covered or not – it has already happened at the government level. …Learn More