Right to Appeal Medicare Decisions for Hospice Patients

When Emily Back lay dying and in excruciating pain, her hospice made a decision that her husband couldn’t accept.

Now a California court decision has resulted in an important clarification, determining that Medicare beneficiaries and their survivors have a right to appeal the denial of services by a hospice provider.

It is always disappointing when Medicare fails patients due to bureaucratic impasses. What’s worse is when the patient is already in hospice care and doesn’t know their rights.

Much can be learned through the unfortunate case of Howard and Emily Back. Emily, now deceased, was a California hospice patient covered by Medicare. Howard appealed his wife’s lack of treatment through the court process. However, the court was quick to point out that there is an administrative appeals process through Medicare regarding its hospice care decisions.

The entire case is detailed in a recent post in The New Old Age a blog through the New York Times, titled “Court: You Can Appeal Medicare Decisions About Hospice Services.” As this blog post notes, Emily was denied coverage for a pain medication while in hospice and in the last stages of life. Consequently, Howard paid for them out of pocket and later (after Emily’s passing) appealed to Medicare to cover the expenses for doctor-ordered medication. While initially told there was no such Medicare appeals process and was turned away, Howard learned otherwise.

As Howard sought to set a precedent so future couples would not face the same roadblocks, the court has finally found and verified that a Medicare appeals process exists. In fact, one can appeal a Medicare decision regarding hospice services with a form labeled “CMS-1490S,” if the beneficiary believes they have been inappropriately denied services.

Many Medicare beneficiaries may have experienced this same short fall when entering hospice care, but hopefully this case can shed light on the solutions that are available to patients and their families.

Reference: The New Old Age blog of The New York Times (September 7, 2012) “Court: You Can Appeal Medicare Decisions About Hospice Services


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