Tag: appeals

Seniors’ Wait For A Medicare Appeal Is Cut In Half

By Susan Jaffe   KAISER HEALTH NEWS  | December 23, 2014

This KHN story also ran in wapo

The federal office responsible for appeals for Medicare coverage has cut in half the waiting time for beneficiaries who are requesting a hearing before a judge.

The progress follows an announcement last January that officials were going to work through a crushing backlog by moving beneficiaries to the front of the line and suspending hearings on cases from hospitals, doctors and other providers for at least two years.

…Still, about 900,000 appeals are awaiting decisions, with most filed by hospitals, nursing homes, medical device suppliers and other health care providers, said Jason Green, OMHA’s program and policy director. The wait times for health providers’ cases have doubled since last year, and are nearly four times longer than the processing time for beneficiary appeals. [Continued in KHN] [Continued in Washington Post]…

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By Susan Jaffe | December 17, 2012  |  Kaiser Health News in collaboration with

Dan Driscoll used to be a smoker. During a regular doctor’s visit, his primary-care physician suggested that Driscoll be tested to see if he was at risk for an abdominal aortic aneurysm, a life-threatening condition that can be linked to smoking. The doctor said Medicare would cover the procedure. So Driscoll, 68, who lives in Silver Spring, had the test done and was surprised when he got a bill from Medicare for $214.

“I didn’t accept that,” he said, because based on everything he had read from Medicare, he was sure this was a covered service. So Driscoll did something that seniors rarely do: He filed an appeal.  Of the 1.1 billion claims submitted to Medicare in 2010 for hospitalizations, nursing home care, doctor’s visits, tests and physical therapy, 117 million were denied. Of those, only 2 percent were appealed.

“People lose, and then they lose heart, or they are too sick, too tired or too old, and they give up,” said Margaret Murphy, associate director of the Center for Medicare Advocacy, which has offices in Washington and Connecticut. “Or their kids are handling the appeal and they are too overwhelmed caring for Mom or Dad.”  [Continued at Kaiser Health News and The Washington Post.]

How To File A Medicare Appeal  Here are some basic steps for challenging Medicare coverage denials…. [Continued at Kaiser Health News.]

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By Susan Jaffe             November 15th, 2012  KAISER HEALTH NEWS

Health care providers who appealed to Medicare judges won more often than patients did,  according to a report by the inspector general at the U. S. Department of Health and Human Services.    

Hospitals, physicians, medical equipment suppliers and other providers also filed 85 percent of the cases decided by the administrative law judges in fiscal year 2010.   Some providers get plenty of practice, with 96 “frequent filers” responsible for one-third of the 40,682 appeals submitted to the judges, the IG found.   [MORE]

Obama administration delaying some rules for appealing health insurance denials

By Susan Jaffe |  March 30, 2011 | Kaiser Health News  produced in collaboration with   

The Obama administration is delaying until next January its enforcement of some new rules designed to protect patients who appeal insurers’ decisions to deny or reduce health care benefits… not affected by the latest government announcement is the timeframe given to consumers to file an appeal. Under most plans, beneficiaries have 180 days after receiving a denial notice to request a review…. more
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