• Perez Health Law

CAN YOU FILE A MEDICARE APPEAL ON BEHALF OF A PATIENT?

Updated: Nov 3

As a physician, you have dedicated years of your life to getting the education necessary to help people with serious medical issues. If there is anything more frustrating than a patient who won’t follow your medical instructions, it may be a dispute with an insurance provider that keeps a patient from getting the care that they need.



If your patient roster includes older adults who receive Medicare benefits, the government has a say in what treatment those patients receive. Sometimes, the determination that Medicare makes about a patient’s benefits could put their health at risk.


Can you potentially appeal on behalf of one of your patients when Medicare claims they don’t need a crucial or recommended form of care?


YES, PHYSICIANS CAN APPEAL FOR PATIENTS WITH MEDICARE COVERAGE


The average Medicare recipient might struggle with the complex process of handling a claim appeal. Thankfully, the government recognizes how older adults may struggle with that process and allows them to have someone else manage an appeal on their behalf.


They could choose family members, or they could ask you, their physician, to initiate the appeal on their behalf. You are in a unique position to assist with a Medicare appeal. You have full access to the patient’s health records and the knowledge to establish the necessity of treatment. You can potentially file an appeal that eventually leads to your patient getting the treatment they need to fully recover.


TALKING TO YOUR PATIENTS ABOUT MEDICARE COVERAGE COULD HELP THEM AND YOU


When patients don’t understand their rights, including the right to appeal, they might forego crucial medical care because they don’t understand their options. Their health could suffer if they don’t receive the care and support that you recommended.


One of the ways you can support your older patients at your practice is by providing them with education about their rights as Medicare beneficiaries and support when they need to appeal an unfavorable benefits decision. You can even talk with them directly if Medicare makes an unfavorable decision about a suggested treatment.


Offering the right support to your patients and helping them with the frustrating Medicare appeals process could lead to better outcomes for your patients and better revenue for your practice.