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1. REASON FOR DENIAL: The treatment, prescription or medical service is unlikely to cause your health condition to improve.
2. REASON FOR DENIAL: You are likely to require care for a very long time… or have already received treatment for a very long time without a resolution of the problem.
3. REASON FOR DENIAL: You do not qualify for Medicare-covered home care because you are not homebound.
4. REASON FOR DENIAL: The dosage level of a prescription is greater than the dosage normally prescribed…
5. REASON FOR DENIAL: Technical errors were made in the original Medicare claim
but don't worry, there is 5 level appeal process. If your Medicare appeal is denied, you have the right to file as many as four more appeals.
Appeal #2: You have 180 days from the date your redetermination request is denied to request that a Qualified Independent Contractor (QIC) make a “reconsideration determination.”
Appeal #3: If your second appeal is denied as well and the amount in dispute is at least $120 ($200 for a hospital inpatient claim), then you have 60 days to file a third appeal, this time with an Administrative Law Judge (ALJ) of the US Department of Health and Human Services. Filing instructions are included with the denial. Get a lawyer.
Appeal #4: If the judge turns down your third appeal, you have 60 days to request that the Medicare Appeals Council (MAC) review the decision.
Appeal #5: If the MAC turns down your appeal, you have 60 days to determine if you wish to hire an attorney and file a judicial review in Federal District Court.
I lived in England for two years and used the national health system. Unless it's changed, it's really a collection of trust funds that control medical care and vary in services offered by geographic location and funding.
I think the English system is more like Medicaid where they have to cover x-number of things but beyond that, it varies by state (California covers a lot more than Mississippi does).
My care was fine but not it's definitely rationed care. For instance, my wife was in her early 30s and in the US, had a PAP test every year as part of her healthcare. In England, it's offered once every three years unless there's a medical reason (previous abnormal test).
The other thing is that it is stacked against the elderly. Our neighbor in her late 70s was told that she was too old for a knee replacement. Never mind if it would have helped her. Hopefully, the laws have been changed to stop that discrimination.
We already have socialized medicine in the form of Medicare, Medicaid, and the VA.
These all have their problems and can be improved upon but who is screaming to eliminate them (like they scream about the ACA)?
Can you imagine Congress introducing a bill to eliminate them?
As a veteran I'll scream all day long to eliminate the VA, the medical "care" there is just completely awful. I think I have used the VA 3 or 4 times after I first got out of the military until I had to threaten them with falsifying medical records when they refused to document my ankle/knee problems to avoid claims...which I wasn't even planning on filing I just wanted my medical records to be accurate Anyone who has been subjected to the VA can tell you that they are not only awful when it comes to medical care but also crooked and dishonest when it comes to medical claims
And the rest of the world has been reading about thousands of Americans dying for lack of pre-emptive healthcare each and every year. Your's to ante up or fold your cards.
One problem with a universal healthcare system is when it is set up like here in Portugal. There is that universal state-run one, but in parallel there is private healthcare with hospitals etc. The private institutions have more money to spend, so they pay doctors and nurses more money, so there is a brain drain on the public system, leading to longer waiting lists. People who can afford it, opt for private healthcare. Eventually there is a two-class healthcare system.
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Originally Posted by pilotpair
I lived in England for two years and used the national health system. Unless it's changed, it's really a collection of trust funds that control medical care and vary in services offered by geographic location and funding.
I think the English system is more like Medicaid where they have to cover x-number of things but beyond that, it varies by state (California covers a lot more than Mississippi does).
My care was fine but not it's definitely rationed care. For instance, my wife was in her early 30s and in the US, had a PAP test every year as part of her healthcare. In England, it's offered once every three years unless there's a medical reason (previous abnormal test).
The other thing is that it is stacked against the elderly. Our neighbor in her late 70s was told that she was too old for a knee replacement. Never mind if it would have helped her. Hopefully, the laws have been changed to stop that discrimination.
The NHS is made up of trusts that run hospitals in an area, they apply for money from central Government through taxes such as income tax and national insurance.
In terms of the elderly, the NHS now has a constitution stating that there can not be any discrimination in relation to treatment in respect of age.
As for PAP Tests, since 2008, all girls aged 12 and 13 have been offered a vaccination against the human papillomavirus (HPV). The vaccine can prevent over 70% of cervical cancers, althgough it is very very rare in under 25's, furthermore you an go to your local doctor at any time and ask to be screened between tests.
Last edited by Brave New World; 03-04-2019 at 06:20 PM..
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Anyone who has been subjected to the VA can tell you that they are not only awful when it comes to medical care but also crooked and dishonest when it comes to medical claims
