April - June 2019

When Medicare Advantage Plans Deny Payment A Medicare denial occurs when your Medicare Advantage Plan does not pay for a medical device, prescription drug or a health care service that was prescribed by your doctor. This is a problem that may compromise your opportunity for a complete recovery. Please be aware an appeal process exists to help you resolve an incorrect denial decision. Appeals Level 1: File a “Redetermination Request Form” to the company handling Medicare claims. The company name is listed on the Medicare Summary Notice (MSN). Appeals Level 2: File a “Medicare Reconsideration Request Form” with the Qualified Independent Contractor (QIC) for reconsideration. Appeals Level 3: Hearing before Administrative Law Judge. File a “Request for Medicare Hearing by an Administrative Law Judge Form”. For 2019, the required minimum amount of a claim is $160. Appeals Level 4: Review by Medicare Appeals Council. File a “Request for Review of an Administrative Law Judge (ALJ) Medicare Decision/Dismissal” form. Appeals Level 5: Federal district court judicial review. File an “Appointment of Representative Form” for your doctor to present this appeal on your behalf. For 2019, the minimum dollar amount is $1,630. Does this sound complicated? Serving Our Seniors OSHIIP certified counselors and Senior Advocates are here to help you to navigate the Medicare appeals process. To learn more about the Medicare Advantage Plan appeal process, you are encouraged to attend the forum on June, 20 from 1:30-3:00 p.m. at the Erie County Office Building in Sandusky. Registration is required; please call 419-624-1856 to sign up. Re-Paying It Forward In 2015, Serving Our Seniors initiated a financial assistance program designed to help older adults who faced challenges in affording dental care and hearing aids. The program also included funds for other important needs where current programs or resources are unavailable. To date, 46 clients have received a total of $10,600 from the Dental Repayment Program, the Hearing Aid Repayment Program, and the Piggy Bank Repayment Fund for miscellaneous needs that are important to maintaining health or independence. To qualify for the repayment programs, individuals must be Erie County residents, aged 60 or older, with at least $50 in income remaining after all of their monthly bills/ obligations are paid. Participants agree to repay the financial assistance they receive based on the honor system. The payments are interest-free, paid back monthly, in an amount that does not cause financial hardship for the client. If you are interested in learning more about financial assistance for your general dental care or if you have a problem that no other social service will address, please call our office and ask to speak with a Senior Advocate Assistant at 419-624-1856. Patricia Stineman, MSIG, CSA, Insurance Education Specialist / OSHIIP Trainer Nancy Rodriquez Wendy Boyer 22 Serving Our Seniors is here when you need help . 419-624-1856 800-564-1856