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Thursday, September 13, 2012

You Can Appeal Medicare Decisions Refusing Payment for Services

If a Medicare beneficiary believes he or she has been inappropriately denied a necessary service, the person can file a claim, on a form labeled CMS-1490S with a Medicare claims contractor and initiate an appeal if the claim is rejected. #in #dox

For example, you have been prescribed a therapy or medication by your doctor which is subsequently denied by Medicare.  The alternative proposed therapy/medication is not appropriate for you or has already been tried and has failed.  Are you stuck with the bill for that service which both you and your doctor determined is in your best interest? 

There is a recourse and you may appeal to Medicare.  Indeed, few patients or doctors are aware of this process to do so.

Of course, it is better to find out if Medicare covers a desired service before hand as it may save a lot of headache later on.  You may do so at, http://www.medicare.gov/coverage/your-medicare-coverage.html