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Medicare Claim Hearings
A July 2005 change in the federal policy, limits Medicare beneficiaries’ access to claims-denials hearings, make it harder for older Americans to participate in Medicare.
When Medicare denies claims for prescription medications, in-home care, nursing home medical services, or other benefits, claimants are now required to attend hearings conducted via videoconference or by telephone with judges supervised by the Department of Health and Human Services in only four cities- Cleveland, Ohio; Miami, Florida; Irvine, California; and Arlington, Virginia.
The recently enacted Medicare drug benefit is expected to create large numbers of claims. Previously, beneficiaries petitioning personal claims-denials hearings could travel to 1 of 140 Social Security offices located throughout the nation. Now, Medicare will conduct face-to-face hearings only under very special circumstances, and those demanding personal hearings forfeit the right to a 90-day decision.
Many legislators, patients’ rights groups, and Medicare attorneys claim four offices were insufficient and worried that the change would result in sick or aging beneficiaries not obtaining just or positive decisions.
