What rules apply to Medicare HMOs?
If you receive Medicare benefits through a Medicare HMO, your HMO has to follow the rules and procedures set down by the Department of Health and Human Services. Like any insurance program, these rules cover issues like how much will be paid for office visits, drugs, medical procedures, therapy, and so on. Your Medicare HMO is required to notify you any time they will be denying your coverage. They have to tell you if: • Your treatment will not be paid for • Your treatment will be only partially paid for • They will not provide a particular treatment • They will be providing less treatment, or • They will not treat you any more They also have to give you written information on your rights to an appeal and how to go about it, including any deadlines you may have to meet when you have to provide documentation. State assistance programs In addition to Medicaid, many states have other medical benefit programs for people in need. These are fully state funded and vary by state. You can inves
