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Maximizing Your Medicare Coverage
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Many seniors and individuals on Social Security disability benefits are baffled when it comes to their entitlement to Medicare. Many of these individuals dole out hundreds of dollars due to Medicare determinations that the doctor’s charge for services was not "customary and reasonable". This results in a Medicare reimbursement that requires them to pay unnecessary out-of-pocket costs. Many times bills from hospitals are only partially paid as a result of a finding by Medicare that the treatment was “not medically necessary”. Medicare regulations contain provisions to appeal adverse decision; however, there are only a few advocates who are available to provide assistance. The legal community has not taken an interest due to lack of an adequate fee mechanisms. Legal Service organizations are over-burdened, understaffed and under-funded to handle the number of claims that exist. Many times, the only voice the individual has is from a hospital social worker whose main interest is to make sure the hospital receives payment from Medicare. Good intentions aside, these social workers do not have the time or training to assist the individual when the Medicare payment falls far short of the total bill. These problems are not addressed in any of the Medicare Reform simply because the main thrust of that reform is aimed toward maintaining the solvency of the Medicare Trust Fund. The elderly and disabled Medicare recipients need adequate resources to assure that they receive proper care at a cost that does not cripple them financially. The individual must have adequate access to advocacy groups that can assure fair administration of their rightful Medicare benefits. Paul Proto Executive Director – Federal Benefits Advisory Group
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