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Appeal Rights for Hospice Care Patients

By September 1, 2017April 13th, 2023No Comments

Medicare, and really any kind ofhealth program from private insurance to public entitlement, is always disappointingwhen it fails patients due to bureaucratic dead ends. It’s even worse when thepatient is a hospice patient.

Much can be learned through theunfortunate case of Howard and Emily Back. Emily, now deceased, was a California hospicepatient covered by Medicare. Howard appealed his wife’s lack of treatmentthrough the court process. However, the court was quick to point out that thereis an administrative appeals process through Medicare regarding its hospicecare decisions.

The entire case is detailed in arecent post in The New Old Age a blogthrough the New York Times, titled “Court: You Can Appeal Medicare DecisionsAbout Hospice Services.” Asthis blog post notes, Emily was denied coverage for a pain medication while inhospice and in the last stages of life. Consequently, Howard paid for them outof pocket and later (after Emily’s passing) appealed to Medicare to cover theexpenses for doctor-ordered medication. While initially told there was no suchMedicare appeals process and was turned away, Howard learned otherwise.

As Howard sought to set aprecedent so future couples would not face the same roadblocks, the court hasfinally found and verified that a Medicare appeals process exists. In fact, onecan appeal a Medicare decision regarding hospice services with a form labeled“CMS-1490S,” if the beneficiary believes they have been inappropriately deniedservices.

This case is illustrative of the inherent problemsthat can occur when the competing interests of patient care and governmentalbureaucracy collide.

Trying to keep up to date on Medicaid,Medicare or any other issues faced by America’s Elderly can be a daunting task.At Idaho Estate Planning, we understand these challenges. We have theexperience and expertise to help you maintain your options and protect yourselfas well as your loved ones now and into the future. Remember, good planning isno accident.