What Can Be Done to Contest a Medicare Denial?
Because of the size and complexity of the Medicare program and because of the desire to contain costs, Medicare coverage is often denied when it should be granted. Sometimes these denials are a result of errors; sometimes they are a result of policy that places cost containment concerns over the needs of individual beneficiaries. Whatever the underlying reasons for the denial, the Medicare program includes an appeals system that is designed, at least in theory, to reverse erroneous denials and to correct mistakes. If the patient’s attending physician feels the care in question is medically necessary and the care is not simply excluded from Medicare coverage (e.g., hearing aids, dental care, skilled nursing facility care when there was not a prior hospital stay), the beneficiary should appeal.
