Medicare Claim Rejected? Fight Back!

Believe it or not, the odds are not stacked against you. Many families appeal – and win.

In my experience, I’ve seen far too many people taking a defeatist attitude when a claim is rejected…and paying thousands of dollars out of their own pockets. And my advice to my clients is always the same: You’re not licked yet!

You can appeal a rejection. And – quite often – you can win. In fact, in certain categories – such as rejections of payments for doctor visits and services covered under Part B – 53% of those who appeal actually won.

Knowing how to appeal, of course, is the key…because appeal procedures vary widely, among original fee-for-service Medicare, a Medicare Advantage plan from a private insurance company, and a Part D prescription-drug plan.

Federally-subsidized Advantage plans are similar to health-maintenance or preferred-provider organizations. If you’re planning to appeal a rejection by one of these, or by a Medicare Part D prescription drug plan, the Centers for Medicare & Medicaid Services has a helpful brochure called “Medicare Appeals.”

If you need help appealing a hospital discharge, or appealing claims under original Medicare, Medicare Advantage, a good resource is www.medicareinteractive.org.

If you have original Medicare, and you want to appeal an end-of-care decision by a home health agency, skilled-nursing facility, hospice agency, or outpatient rehabilitation facility, try the Center for Medicare Advocacy, which publishes booklets on the appeals process.

And if at first you don’t succeed…try, try again. In most cases, appeals can be heard up to five times!

You also may want to consider using an attorney or advocate, along with going to organizations like the Medicare Rights Center, the State Health Insurance Assistance Program, and the National Association of Healthcare Advocacy Consultants (nahac.com).

Let’s face it…trying to find answers to Medicare questions usually leads only to more questions. But we can help.

At The Law Offices of Alice Reiter Feld & Associates, we’ve been practicing Elder Law in South Florida for 33 years. We’ve answered Medicare questions for thousands of families. And we’ve helped them, as well, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid and the VA.

We can answer your Medicare questions. And we’re just a phone call away.

Think Medicare HMO Advantage Covers Everything? Think Again!

If you’re enrolling in Medicare, you need to know the facts about out-of-pocket costs associated with HMO Advantage plans. Make no mistake – these plans can be appropriate for a lot of people. But you’d better make sure you’re one of them. And you should know the risks before you sign up.

To many of us, “out-of-pocket” costs mean co-pays to primary-care physicians and specialists. But, if you need services such as out-patient rehabilitation for physical, occupational, or speech therapies, or cardiac and pulmonary rehabilitation, your co-pays can balloon up to $100 per session. And these payments could be considered “out-of-pocket” – which means they could be part of your annual deductible.

Healthcare professionals tell me they’re seeing an increasing number of seniors go without the therapies they need, because they just can’t afford them. Apparently, they never really thought about longer-term therapies that might be needed for serious injuries or illnesses, or they thought those conditions would be covered the same way as others. But it ain’t necessarily so!

These plans can have a low up-front cost…but before you pick one, you’d better be truthful with yourself about any potential health problems. You’d better have a full understanding of the co-pays, deductibles, and out-of-pocket costs. And you’d better know exactly what’s covered; after a cardiac event, for example, exercising at a local gym is not quite the same as cardiac rehabilitation!

The best money-saving tip of all, though, is this: Take care of yourself! Exercise, eat right, get enough sleep, and “live well” before you get any older…and you’ll automatically cut your future medical expenses.

Trying to figure out the best Medicare plan for yourself can be a very intimidating process. And it generally leads to more questions than answers. But we can help.

At The Law Offices of Alice Reiter Feld & Associates, we practice Elder Law. And we’ve been practicing it in South Florida for 33 years. We can answer your questions about Medicare. And we can help you prepare for the future, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid (and Medicare!) and the VA.

If you’ve got questions, we’ve got answers. And we’re just a phone call away.

Medicare Targets South Florida

Five Florida hospitals, including Memorial in Hollywood and Jackson in Miami have scored so poorly regarding readmission rates that they are actually getting a grant to fix things up.   This means that too many Medicare patients that are discharged a being readmitted within weeks or even days to the same or another hospital.

Hospital Readmissions has become such a problem that the new health care bill includes sanctions for hospitals who do not address this issue.

Obviously hospital readmissions are very costly for Medicare and are often preventable with concentration on a “team approach” to making discharge more comprehensive, educating the patients and family and using all resources in the community.  This comprehensive approach has also shown to reduce the patients stay in the hospital.

Obviously addressing these issues is not only good for Medicare but for the patients as well.  We routinely get calls from frantic family members whose elderly relative is being released from a hospital and they have no idea what to do next.  Typically the elder was independent before; now they may need a higher lever of care.

We appreciate the overwhelming burden discharge planners have and work with them and the family with regard to placement, public benefits and a myriad of issues a family has when an elderly loved one is discharged from a hospital.  Putting the elder law attorney as part of the comprehensive team approach can reduce readmissions to hospitals, benefiting Medicare, the patient, their family and the hospital.

Our firm advocates for seniors and senior care, so we have made a significant investment in acquiring the best materials and resources that address the unique needs of these communities. We also offer a unique suite of resources to aide the Caregivers to Alzheimer’s patients. We are pleased to make these valuable resources available to you COMPLETELY FREE OF CHARGE. These materials represent the initial steps you need to take to provide the best possible care for yourself, your family members, clients, patients and friends. Sign up for one or all of these unique and valuable online resource centers:

www.medicaidcrisislawyers.com/reiterfeld

www.estateandlonglifeplan.com/reiterfeld

www.learnvabenefits.com/reiterfeld

and

www.southfloridamemorylawyer.com for caregivers to Alzheimer’s patients.

You may also visit our website any time for access to information on all of the areas of law we practice under “The Elder Law Umbrella” at www.florida-elderlaw.com or follow our blog: www.southfloridaelderlaw.blogspot.com