header image

[Sign Up Now] to Receive Our FREE Daily SCVTV-SCVNews Digest by E-Mail

Inside
Weather


 
Calendar
Today in
S.C.V. History
September 20
1954 - C-46 cargo plane crashes at Saugus Drunk Farm; Civil Air Patrol chaplains parachute to safety [story]
chaplains


Commentary by Cate Kortzeborn
| Tuesday, Aug 16, 2016

CateKortzebornAs a person with Medicare, you have important rights. One of them is the right to appeal.

An appeal is the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare health plan. For example, you can appeal if Medicare or your plan denies:

* A request for a health care service, supply, item, or prescription drug that you think you should get.

* A request for payment of a health care service, supply, item, or prescription drug you already got.

* A request to reduce the amount you must pay for a health care service, supply, item, or prescription drug.

You can also appeal if Medicare or your Medicare Advantage plan stops providing or paying for all or part of a health care service, supply, item, or prescription drug you think you still need.

If you decide to file an appeal, you can ask your doctor, supplier, or other health care provider for any information that may help your case. Keep a copy of everything you send to Medicare or your health plan as part of your appeal.

How you file an appeal depends on the type of Medicare coverage you have. If you have Original Medicare:

1. Get the “Medicare Summary Notice” (MSN) that shows the item or service you’re appealing. Your MSN is the notice you get every 3 months that lists all the services billed to Medicare, and tells you if Medicare paid for the services.

2. Circle the item(s) you disagree with on the MSN, and write an explanation of why you disagree with the decision on the MSN or a separate piece of paper and attach it to the MSN.

3. Include your name, phone number, and Medicare number on the MSN, and sign it. Keep a copy for your records.

4. Send the MSN, or a copy, to the company that handles bills for Medicare (known as the Medicare Administrative Contractor) listed on the MSN. You can include any additional information about your appeal. Or you can use CMS Form 20027 and file it with the company that handles bills for Medicare. To view or print this form, visit www.cms.gov/cmsforms/downloads/cms20027.pdf. Or call 1-800-MEDICARE (1-800-633-4227) to have a copy mailed to you. TTY users should call 1-877-486-2048.

You must file the appeal within 120 days of the date you get the MSN in the mail. You’ll generally get a decision from the Medicare Administrative Contractor within 60 days after they receive your request. If Medicare will cover the item(s) or service(s), they’ll be listed on your next MSN.

If you have a Medicare Advantage or other health plan, read the materials your plan sends you, call your plan, or visit www.Medicare.gov/appeals. In some cases, you can file an expedited, or fast appeal.

If you have a Medicare prescription drug plan, even before you pay for a given drug, you have the right to:

* Get a written explanation (called a “coverage determination”) from your Medicare drug plan. A coverage determination is the initial decision made by your Medicare drug plan (not the pharmacy) about your benefits, including whether a certain drug is covered, whether you’ve met the requirements to get a requested drug, how much you pay for a drug, and whether to make an exception to a plan rule when you request it.

* Ask for an exception if you or your prescriber (your doctor or other health care provider who’s legally allowed to write prescriptions) believe you need a drug that isn’t on your plan’s formulary.

* Ask for an exception if you or your prescriber believe that a coverage rule (like prior authorization) should be waived.

* Ask for an exception if you think you should pay less for a higher tier (more expensive) drug because you or your prescriber believe you can’t take any of the lower tier (less expensive) drugs for the same condition.

For more information on exceptions and your other Medicare rights, read the “Medicare & You 2016” handbook, at https://www.medicare.gov/Pubs/pdf/10050.pdf.

 

Cate Kortzeborn is Medicare’s acting regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

Comment On This Story
COMMENT POLICY: We welcome comments from individuals and businesses. All comments are moderated. Comments are subject to rejection if they are vulgar, combative, or in poor taste.
REAL NAMES ONLY: All posters must use their real individual or business name. This applies equally to Twitter account holders who use a nickname.

0 Comments

You can be the first one to leave a comment.

Leave a Comment


Opinion Section Policy
All opinions and ideas are welcome. Factually inaccurate, libelous, defamatory, profane or hateful statements are not. Your words must be your own. All commentary is subject to editing for legibility. There is no length limit, but the shorter, the better the odds of people reading it. "Local" SCV-related topics are preferred. Send commentary to: LETTERS (at) SCVNEWS.COM. Author's full name, community name, phone number and e-mail address are required. Phone numbers and e-mail addresses are not published except at author's request. Acknowledgment of submission does not guarantee publication.
Read More From...
RECENT COMMENTARY
Thursday, Sep 19, 2024
As my wife, Virginia, and I stroll through our magnificent city, we admire the beautiful paseos and the expansive open spaces, but what really catches our eye, is the diverse works of art at every turn.
Friday, Sep 13, 2024
As a father of three, I understand firsthand the importance of guiding our children through open communication and keeping them engaged in extracurricular activities and sports to foster their growth.
Thursday, Sep 12, 2024
You may have noticed that things look a little different around our city. Maybe you noticed the motion sensor lights at our parks, or the solar panels being installed in city parking lots.
Wednesday, Sep 11, 2024
California State  Sen. Scott Wilk (R-Santa Clarita) is urging residents to prepare an emergency evacuation plan as the Line Fire, Bridge Fire and several other wildfires continue to pose a serious threat to High Desert and foothill communities.
Wednesday, Sep 11, 2024
As we approach the November 2024 elections, the importance of informed voting cannot be overstated. The choices we make at the ballot box will shape the future of our city, state and nation. Yet, in an era where soundbites often substitute for substantive discussion, how can voters truly grasp the complexities of the issues at hand?
Friday, Sep 6, 2024
As scorching triple-digit temperatures engulf Los Angeles County throughout the weekend and excessive heat warnings have been issued for many communities in Los Angeles County’s Fifth District, I urge residents to do their part to lessen the threat of wildfires.

Latest Additions to SCVNews.com
1954 - C-46 cargo plane crashes at Saugus Drunk Farm; Civil Air Patrol chaplains parachute to safety [story]
chaplains
The College of the Canyons Aerospace and Science Team has received a $300,000 grant from NASA’s Mentoring and Opportunities in STEM with Academic Institutions for Community Success program.
COC Receives $300,000 NASA Grant to Expand Student Access to STEM Fields
Bring along a furry friend to the Santa Clarita Child & Family Center's Purple Walk Domestic Violence Awareness 5K on Saturday, Oct. 5 from 8-11 a.m. at the Center’s main facility 21545 Centre Pointe Parkway, Santa Clarita, CA 91350.
Oct. 5: 5K Purple Walk Dogs Against Domestic Violence
Written and directed by Braddon Mendelson, produced by Heather Mendelson, and co-produced by Olive Branch Theatricals and Noisivision Studios, "Provenance" will take stage at the The MAIN, 24266 Main Street, Santa Clarita, CA 91321, Friday through Sunday, Sept. 27-29.
Sept. 27-29: Braddon Mendelson to Present ‘Provenance’ at The MAIN
The Master's women's volleyball team opened Great Southwest Athletic Conference play on the road in Prescott, Ariz. on Wednesday, Sept. 18, defeating the Embry-Riddle Aeronautical University Eagles in straight sets 28-26, 25-22, 25-18.
TMU Women’s Volleyball Opens Conference Play with Road Win
College of the Canyons freshman Sahya Kitabatake shot a two-under-par round of 70 to tie for medalist honors while helping the Cougars place fourth at the Western State Conference tournament at Sterling Hills Golf Club in Camarillo on Monday, Sept. 16.
Kitabatake Medals, Canyons Women Take Fourth at Sterling Hills Golf Club
One of the city of Santa Clarita community’s most cherished parks, David March Park is set to expand, Thursday, Sept. 26, at 10 a.m., 28310 North Via Joyce Drive, Santa Clarita, CA 91350 with a groundbreaking ceremony.
Sept. 26: Community Invited to David March Park Expansion Groundbreaking
SRD Straightening Reigns, a therapeutic organization offering equine assisted psychotherapy, has been awarded $278,870 from the California State budget to improve mental health services.
California Awards $278,870 in Funding to SRD Straightening Reins
The Santa Clarita Community College District Board of Trustees appointed Carlos Guerrero to fill the board seat in Area 5, effective immediately, at its special Wednesday, Sept. 18 meeting.
COC Board of Trustees Appoints Carlos Guerrero to Area 5 Seat
California Institute of the Arts alums Alyssa Dressman Lehner and Clara Plestis captured Emmy Awards at the 76th Primetime Creative Arts Emmy Awards.
Two Calartians Win 2024 Creative Arts Emmy Awards
Valencia High School's Choir will hold a fall concert, "Broadway, Movies & Media" at 7 p.m., Thursday, Sept. 26 at 7 p.m. and Friday, Sept. 27, 7 p.m. at the Saugus High School Theatre, 21900 Centurion Way, Santa Clarita, CA 91350.
Sept. 26-27: Valencia High Choir Presents Fall Concert ‘Broadway, Movies & Media’
As my wife, Virginia, and I stroll through our magnificent city, we admire the beautiful paseos and the expansive open spaces, but what really catches our eye, is the diverse works of art at every turn.
Bill Miranda | Santa Clarita Arts, a Journey Through Creativity
The California Department of Public Health is encouraging all Californians to get vaccinated this season to protect themselves and loved ones from respiratory viruses.
CDPH: Stay Up to Date on Vaccines
The Friends of Santa Clarita Public Library in collaboration with Santa Clarita Valley Libraries will have a silent Book Auction beginning at 9 a.m. Monday, Sept. 30, through 10 a.m. on Monday, Oct. 7.
Sept. 30: Public Libraries to Host Silent Book Auctions
1863 - Gen. Edward F. Beale loans money to A.A. Hudson and Oliver P. Robbins to erect toll house in Newhall Pass [story]
toll house
The Counties of Los Angeles and San Bernardino today announced the opening of multiple joint Local Assistance Centers to assist residents impacted by the Bridge and Line Fires.
Joint Assistance Centers Open for Residents Impacted by Bridge, Line Fires
Valencia Gynecology Associates, owned by longtime Santa Clarita Valley OB-GYN physician Don Nishiguchi, MD, has joined the Henry Mayo Newhall Hospital network. 
Valencia Gynecology Assoc. Joins Henry Mayo Network
JCI Santa Clarita is proud to announce the upcoming Veteran’s Resource Fair, scheduled to take place on Sept. 21 at William S. Hart Park. 
Sept. 21: JCI Invites All Veterans to Upcoming Resource Fair
A "friendies" field tournament  is being  hosted by the Saugus Instrumental Music program, with support from Valencia High, later this month. 
Sept. 21: All Valley Showcase Comes to Valencia High
Public, member-supported 88.5 FM The SoCal Sound, Southern California’s leading Triple-A (adult album alternative) format radio station has announced the lineup for its inaugural “Year-End Bash” taking place on Saturday, Dec. 7.
Dec. 7: CSUN Owned 88.5-FM The SoCal Sound Announces “Year End Bash” Lineup featuring Ben Gibbard
The Master's University cross-country teams continued their successful 2024 campaigns with strong finishes at the BIOLA Invitational on Friday, Sept. 13 at Craig Regional Park in Fullerton, Calif.
TMU Women Win, Men Place Second at XC Invitational
Sheriff’s Department Announces New Law Enforcement Gang Policy
LASD Announces New Policy on Law Enforcement Gangs
The biology department at California State University, Northridge has stayed committed to promoting STEM research carried out by K-12 students and teachers in the Los Angeles Unified School District.
CSUN Student Research Journal Celebrates 28 Years of Inspiring Scientific Imagination
Did you know the SCVEDC has an interactive, online tool that provides themed virtual tours of the amazing features the community has to offer? 
SCVEDC Offers Virtual Business Tours of the Santa Clarita Valley
SCVNews.com