[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”