How to be a Patient Advocate for Medicare Benefits
One of the core concepts of elder law is that of advocacy for an elder who needs assistance. We have found that is especially true in the medical arena. Too often an elder does not get sufficient treatment to recover from a condition or to maintain independent living.
Advocacy is important, but how does one accomplish GOOD advocacy? In addition to the value of being persistent the advocate must be INFORMED. This can be especially difficult in the healthcare area because we rely upon doctors to make medical decisions, including the decision that treatment will no longer be beneficial.
We have written before how the healthcare system makes mistakes by not reviewing all relevant information. (See blog post “How to avoid the two most common serious medical mistakes.”) This is a situation where the patient advocate can be greatly beneficial in making sure the doctor has all needed information about the patient. For example, if the advocate provides a complete list of medications, supplements and botanicals that the patient takes, the doctor can review the list for conflicts with prescriptions.
But, what about Medicare? What about when a provider, say a home health agency, says Medicare will no longer pay for service? Is that the right decision? Is this a case of cost savings at the expense of patient good health? We have heard reports that some Detroit area hospitals will stop referring patients for out patient care to an agency that makes sure the patient receives the best complete treatment.
What does the patient advocate to do when faced with a denial of Medicare coverage? The answer is be informed about Medicare benefits and the appeal process. Fortunately there is consumer help easily available.
The Center for Medicare Advocacy has an incredible store of information and how-to advice. They have consumer self help materials including Comprehensive Tookits, checklists for appeals and up to date information on issues in Medicare. Here is a link that every patient advocate should have bookmarked: https://www.medicareadvocacy.org/take-action/self-help-packets-for-medicare-appeals/
Here’s to Your Health!
Jim