Dear Marci

Dear Marci -- Your trusted source for Medicare answers

Topic of the Month:


Medicare Appeals


This week in Marci...

Volume 9, Issue 9: Week of March 1, 2010

Dear Marci,

Medicare is refusing to pay for a health care service I received. Is there anything I can do?

—Donald (Edina, Minnesota)


Click on the blue, underlined hyperlinks for related information available through Medicare Interactive!


Dear Donald,

If Medicare is refusing to pay for a health care service you received, you can appeal the decision. You have legal rights to get the care you are entitled to regardless of which type of Medicare you choose. These rights exist in Original Medicare and Medicare private health plans.

It is not difficult to exercise your rights and appeal a Medicare denial of a service you believed was necessary. Exercising your rights is easy if you know what to do. Most people who make an appeal are successful.

Click on this link to get help you with your appeal. And remember to:

  • Have your doctor help with the appeal.
  • Read everything carefully.
  • Meet deadlines.
  • Call your insurance provider for more information.
  • Keep good records of everyone you speak with.

Remember that there is no punishment for challenging a Medicare decision. Everyone with Medicare has the right to make sure they are getting the health care coverage they deserve. You should feel free to ask questions about the coverage and services you need. You should also feel free to appeal any denials you get.

In most cases, you do not need a lawyer to begin the appeals process. The general process of appealing a health care denial is straightforward enough to do yourself. If your request is denied and you need to continue to appeal at upper levels, you may want to enlist the help of a lawyer or other advocate.

To find out more about more about your right to appeal, go to Medicare Interactive.

—Marci


Looking for past Dear Marci Answers? Have other Medicare questions? Find your answers with Medicare Interactive (MI), an independent, public resource of the Medicare Rights Center. MI offers expert information and advice on Medicare. Visit Medicare Interactive today!

Search MI here:

Do you need individual counseling? Call the Medicare Rights Center's consumer hotline at 800-333-4114, between 9 a.m. and 5 p.m., Eastern Time, Monday through Friday. A Medicare counselor will be happy to answer your question.

You can also call your State Health Insurance Assistance Program (SHIP) for personal counseling on Medicare benefits, rights and options. Call Social Security (800-772-1213) for questions about enrolling in Medicare or applying for Extra Help!

Feel free to send comments about Dear Marci or suggestions about topics you would like Dear Marci to cover.


Health Tip of the Week

Even vitamins or over the counter medications can be harmful if they are taken incorrectly or in combination with other medications that they might not mix well with. The University of Virginia Health Systems has some tips published in HealthDay News to prevent problems you might have with your medications.

  • Know that vitamins, supplements and over the counter medications can have side effects if taken incorrectly.
  • Inform all of your doctors about all of the medications you take including vitamins, supplements and over the counter medications.
  • Keep a record of all the medications you take and when you take them.
  • Make sure to store all your medications properly.
  • Follow the instructions on the label of the medication and pay attention to any warnings.
  • Find out how certain foods and other medications will interact with any medications you take.
  • Learn about potential side effects and contact your doctor if you have any problems.
  • Do not be afraid to ask your doctor or pharmacist any questions about your medications.

  • Survey Says . . .

    According to a study in the January issue of the Archives of Neurology, physical activity might help people avoid or even improve mild cognitive impairment.

    Mild cognitive impairment is defined in an article in HealthDay News as “…an in-between state between the normal changes in thinking, learning and memory that come with age and dementia”.

    The results of this study are significant because they show how important exercise is. Not only is it important for staying physically fit, according to these studies it is also important in preventing or improving cognitive impairment.

    The study included 1,324 participants without dementia who were a part of the Mayo Clinic Study of Aging. These participants filled out a questionnaire about their physical activity and were assessed to have normal cognition or mild cognitive impairment.

    The study found that participants who had done moderate exercise during their midlife were 39 percent less likely to have mild cognitive impairment. Those who did moderate exercise later in life were still 32 percent less likely to have mild cognitive impairment.

    “… Exercise may guard against mild cognitive impairment through production of nerve-protecting compounds, increased blow flow to the brain, improved development and survival or neurons, and decreased risk of heart and blood vessel disease” according to the team at the Mayo Clinic.

    This study clearly shows the beneficial effects of physical activity on cognitive functioning.

 

Spotlight on Resources

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The Medicare Rights Center's Hotline for Professionals

Do you help people with Medicare? Where do you turn to for help? Call the Professional Hotline, a national service offered by the Medicare Rights Center to support people serving the Medicare population. Dial 877-794-3570 from 9 a.m. to 6 p.m. Eastern Time for accurate, up-to-date information and ongoing technical support.

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March is National Colon Cancer Awareness Month

Check out The Susan Cohan Kasdas Colon Cancer Foundation for information, tips and resources about Colon Cancer prevention and screening.

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Bulletin: New Extra Help Application for 2010

In 2010 there will be some changes to the Extra Help application. Extra Help is a federal program that can help you pay for some or most of the costs of Medicare prescription drug coverage if your income and assets are below a certain level. To be sure you get all the benefits you qualify for, complete the entire Extra Help application, even if you do not think you qualify for Extra Help. For more information click here.

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Dear Marci is a weekly e-newsletter designed to keep you—people with Medicare, social workers, health care providers and other professionals—in the loop about health care benefits, rights and options for older Americans and people with disabilities. Dear Marci is a free service of the Medicare Rights Center.


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