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    Oct 2 12

    Appeal Rights for Hospice Care Patients

    Newport Beach Law Firm

    [The unfortunate case of Mr. Back and his
    case against Medicare] makes it clear that beneficiaries have the right to
    challenge a hospice provider’s refusal to provide a service that a doctor deems
    necessary, Mr. Deford said. But it’s disappointing because it doesn’t ensure
    that people receive a notice of their right to appeal when they enter hospice
    care, or that any mechanism exists for expedited appeals – an important
    protection for people who are dying.

    Medicare, and really any kind of
    health program from private insurance to public entitlement, is always disappointing
    when it fails patients due to bureaucratic dead ends. It’s even worse when the
    patient is a hospice patient.

    Much can be learned through the
    unfortunate case of Howard and Emily Back. Emily, now deceased, was a
    California hospice patient covered by Medicare. Howard appealed his wife’s lack
    of treatment through the court process. However, the court was quick to point
    out that there is an administrative appeals process through Medicare regarding
    its hospice care decisions.

    The entire case is detailed in a
    recent post in The New Old Age a blog
    through the New York Times, titled “Court: You Can Appeal Medicare Decisions
    About Hospice Services
    .” As
    this blog post notes, Emily was denied coverage for a pain medication while in
    hospice and in the last stages of life. Consequently, Howard paid for them out
    of pocket and later (after Emily’s passing) appealed to Medicare to cover the
    expenses for doctor-ordered medication. While initially told there was no such
    Medicare appeals process and was turned away, Howard learned otherwise.

    As Howard sought to set a
    precedent so future couples would not face the same roadblocks, the court has
    finally found and verified that a Medicare appeals process exists. In fact, one
    can appeal a Medicare decision regarding hospice services with a form labeled
    “CMS-1490S,” if the beneficiary believes they have been inappropriately denied

    This case is illustrative of the
    inherent problems that can occur when the competing interests of patient care
    and governmental bureaucracy collide.

    Reference: The New Old Age
    blog of The New York Times
    (September 7, 2012) “Court: You Can Appeal Medicare Decisions
    About Hospice Services

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