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Healthcare Reform - Legal Rights and Medicare
As healthcare reform continues to dominate the news, now is a good time to look at your legal rights under Medicare, the biggest government program that affects millions of Americans. Pictured here is Attorney Joseph S. Carp, whose practice includes Medicare legal issues.
Medicare is a health insurance program run by the U.S. government. It is a single payer health care system that covers people over the age of 65 and others who meet special status criteria. In our opinion, the websites run by the government, like medicare.gov, can be pretty confusing, so we're working on delivering the simple information and easy tools you need to exercise your healthcare legal rights. Medicare consists of four parts - Part A through Part D.
Medicare Part A (hospital insurance) covers hospital care, limited post-hospital skilled nursing facility care, part-time home health services, and hospice care. If you are 65 years old or over, you can receive Medicare Part A insurance without having to pay a premium if you are currently receiving or eligible to receive but have not yet filed for either Social Security or Railroad Retirement benefits or if you or your spouse had Medicare-covered employment by the government. If you are under 65, you can receive Medicare Part A insurance without having to pay a premium if you have received either Social Security or Railroad Retirement benefits for twenty-four (24) months or if you are a kidney transplant or kidney dialysis patient. If you have been denied a Medicare Part A claim, click here for a Medicare Part A Appeal Denial Form.
Medicare Part B (Supplemental Medical Insurance) covers physician's services, certain outpatient hospital services (including emergency room visits), ambulances, diagnostic tests, laboratory services, certain preventive care services such as mammography and pap smear screening, outpatient therapy services, durable medical equipment and supplies, and home health care services not covered by Part A.
Medicare Part B pays 80% of approved charges for most covered services. The beneficiary is responsible for paying a deductible each calendar year as well as the remaining 20% of the Medicare approved charges. The beneficiary may have to pay additional charges if the doctor providing the care does not agree to Medicare's approved charges. If you have been denied a Medicare Part B claim, click here for a Medicare Part B Appeal Denial Form.
Medicare Part C (Medicare Advantage plans) gives Medicare beneficiaries the option of receiving their Medicare benefits from private health insurance plans.
Medicare Part D (Prescription Drug plans) makes those eligible for Medicare Parts A or B, eligible for certain access to funded prescription drug benefits.
What Should You Do About the Denial of a Medical Insurance Claim?
Every day, many people find themselves in one of life's most distressing situations - having a health care insurance claim denied. Sadly, it's a fact of life that our healthcare system routinely results in denied claims for medical services and care that people need and probably should be entitled to under their existing insurance policy. What should you do if a healthcare insurance claim of yours is denied?
Well, there is more and more public momentum toward cleaning up health care and claims denials. Robyn Shelton writes in the Orlando Sentinel that if you are denied a health insurance claim, "you should appeal." She goes on to write:
"First off: Don't panic. Many claims are rejected initially for glitches that can be sorted out rather easily. Do not pay a bill without making some calls." Read more...
In her article "The Health-Care Crisis Hits Home," Karen Tumulty recounts her family's ordeal as her brother had to fight the twin battles of kidney disease and a denial of his insurance coverage. Stories like these are all too familiar to millions of people:
"The unforeseen was exactly what turned up when Pat went in for a physical on Nov. 30, 2007, his first in five years. The doctor found high levels of blood and protein in his urine, results that were confirmed in another round of tests in December. Soon after that, Pat discovered that his urine had turned brown and foamy. In the middle of all this, he was laid off from his job, and finding a new one while doing temp work was his most pressing concern...That's when Pat, who is now 54, learned that his kidneys were failing. The diagnosis was only the first shock. The second came a few weeks later, in an Aug. 5 letter from Pat's health-insurance company (denying his claim). For six years — since losing the last job he had that provided medical coverage — Pat had been faithfully paying premiums to Assurant Health, buying a series of six-month medical policies, one after the other, always hoping he would soon find a job that would include health coverage...The previous four weeks had left my brother with more than $14,000 in bills from hospitals, doctors and labs..." Read more...
If you are facing an insurance claim denial, you can follow a few simple steps to first become informed about your rights, and second, fight the claims denial yourself, with the assistance of government agencies, and, if needed, your own lawyer.
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