Carmel, CA Appealing A Medicare Denial Could Be Worth The Waitby Richard Kuehn on 10/25/12
Most people assume that if their insurance company declines payment on a procedure or office visit, there's nothing they can do. That's not true, all insurance companies have an appeals process and although it can be time consuming and annoying, it's sometimes worth sticking it out and going through it. The Wall Street Journal recently pointed out that there's actually a very high success rate for those who appeal Medicare denials. Folks don't appeal as much as they should," Doug Goggin-Callahan, director of education at the non-profit Medicare Rights Center told The Wall Street Journal. "If you and your doctor feel you should be entitled to a service, you should go through the process," he recommended. Believe it or not, each appeal can be heard five times, so don't give up is his recommendation. According to the Centers for Medicare and Medicaid Services, Part A (Hospitalizations and other services) are denied 14.1 million times per year but only 295,000 appeals are filed. Of those who appeal, however, 40% are successful in their first round of the appeals process. Doctor visits and other services covered by Medicare Part B are denied a whopping 93 million times per year, and yet only 2.4 million appeal them. Of those appealed, however, 53% are successful in their first round of appeals. Now I like those odds!