Denied Medicare Advantage Plan Treatment in Idaho? You Can Appeal

If you (or a loved one) have aMedicare Advantage plan, then it is important to be prepared should the planitself overrule your doctor and deny you coverage. That certainly would be anunfortunate turn of events! Fortunately, you can seek to overrule coveragedenied by your Medicare Advantage plan, but you must know how.

While you can be deniedcoverage, it is important to remember that the Medicare Advantage plan is notthe final arbiter and you can appeal their decision. This is an important rightbuilt into the very structure of Medicare. A timely article in titled “Appealing Medicare Advantage Plan Decisions”provided some insights into this process. 

Did you know that above everyMedicare plan is the judicial oversight of an Administrative Law Judge (ALJ)?When the plan makes an adverse coverage decision, first you should appeal totheir better judgment. If you are unsuccessful, then you can go over theirheads and appeal to the ALJ.

But wait, there is more. If youare unsuccessful before the ALJ, then go even higher to the Medicare AppealsCouncil (MAC). Be aware, however, that at this level the process becomes amatter of litigation and all that entails time and money. Nevertheless,litigation is sometimes a necessary evil to pursue necessary care (andjustice).

You may never need to challengea denial of coverage. In case you do, however, it is best to be prepared andthat means being well-informed regarding your rights.

For more information on this and otherestate planning subjects, contact IdahoEstate Planning and schedule aconsultation. Remember,good planning is no accident.



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