Medicare needs authorization to disclose health details; Covering; The Bases

My mother's health is declining. It is becoming increasing difficult for her to manage her daily affairs. She requested that I help her with her legal and financial affairs. I have two shoe boxes full of medical statements from Medicare. Everything looks OK. However, I want to know what legal documents are required for me to speak, on her behalf, to Medicare about her Medicare claims/services? I have power of attorney and medical power of attorney. Will this suffice?

Specifically for Medicare, you will want to have your mother grant authorization for Medicare to disclose health information. There is a specific form that is required: CMS-10106. This form is available online at www.medicare.gov (go to the tab for "Forms, Help and Resources" at the top of the home page and click on "Medicare forms"). Or you may call 1-800-Medicare and request a form be mailed to your home.

I have Original Medicare and had a procedure that Medicare should have covered but denied the claim. My doctors said the procedure was medically necessary and was surprised that Medicare denied the claim. His office reviewed the claim and verified that everything was submitted correctly. What recourse do I have?

You will want to file an appeal with Medicare. If you have a copy of your Medicare summary notice, it will provide instructions on how to file an appeal. You will need to circle the claim in dispute. Be sure to sign the appeal portion of the Medicare summary notice. You will want to write why you disagree with the denial. You state that your doctor believes that the procedure was medically necessary. Ask your doctor to provide supporting information documenting medical necessity.

Be sure to include your name, address, phone number and Medicare number on all correspondence. Keep a copy of all the information you send to Medicare. Your Medicare summary notice will have the address to which you will send your appeal.

If you do not have a copy of your MSN, you may call 1-800-MEDICARE and request a copy. You may also use the www.mymedicare.gov portal to access your Medicare summary notices.

Your appeal will be returned to the Medicare contractor for their reconsideration. If the appeal is approved, Medicare will approve the procedure. If the appeal is denied, you will have instructions on how to begin the next level of appeal.

The second level of appeal will go to a qualified independent contractor for review. There are other levels of appeal beyond the second level. More information about the levels of appeal is available at www.medicare.gov.

Amy Rubino is the director of the

Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging and Disabilities. You may contact either program at 410-222-4257 or [email protected].

Credit: Amy Rubino - Amy Rubino is the director of the ;Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging and Disabilities. You may contact either program at 410-222-4257 or [email protected].