Appealing Medicare Decisions

Medicare recipients have appeal options when coverage for certain drugs is denied.
The Wall Street Journal (2/14, Tergesen) reported that each year, millions of Medicare recipients discover that their drugs are no longer covered by their Part D plans. While seniors in this situation can often substitute generic drugs for brand-name ones, they also have the option of appealing the denial, particularly if their plan did not notify them in a timely manner of the changes. The Journal said that typically, seniors who appeal have a good chance of success, but, in case their appeal is denied, they have 60 days to file a second appeal to Maximus Federal Services (www.medicarepartDappeals.com ).
LATimes offers advice for appealing a denied health insurance claim. The Los Angeles Times (2/15, Worth) offered suggestions on how to appeal a denied health insurance claim. While it can be a "daunting task," the Times suggests that "if you think you've been overcharged or that a claim has been wrongfully denied, there's no reason to take it lying down. You might want to call in reinforcements, though." The Times noted which agencies or organizations to approach depending on what kind of insurance one has.