22 North Shore Towers Courier n October 2016 MEDICARE CORNER Knowing Your Rights You have a right to appeal decisions made by Your Medicare Plan or Medicare The following are the areas that beneficiaries most often file an appeal: • A denial for a health care service or prescription drug coverage, which you and your doctor deem ‘Medically Necessary.’ • Prescription Drug not on formulary; request to lower tier; exception for quantity limit; prior authorization If you are enrolled in original Medicare, Medicare is primary, follow the instructions for appeal on your Medicare Summary Notice (MSN) or on your Explanation of Benefits (EOB) from your prescription drug company. If you receive health coverage through a Medicare Advantage Plan, to file an appeal follow the instructions sent to you by the plan. You may also call the plan for appeal instructions. Advance Beneficiary Notice If you receive your health coverage through original Medicare, your doctor, supplier or provider may give you an ‘Advance Beneficiary Notice’ (ABN) for services, which they know will probably not be paid for by Medicare. You will be asked to sign the ABN with the understanding, that if Medicare denies payment and no other insurer will pay, you will be responsible. An ABN is not a denial of service by Medicare, therefore always request the supplier, doctor or provider to submit claims for service to Medicare. Do not sign a blank or partially completed ABN. BY FELICE HANNAH If you should have received an ABN from your doctor, provider or supplier and did not, you may be entitled to reimbursement from the providers, doctors or suppliers for the amount you paid Consequently, if a provider, doctor or service provider knows that Medicare never covers a service, they are not required to give you an ABN. If you are enrolled in a Medicare Advantage Plan call your plan to ask about covered items and or procedures. You may also get an ABN if you are in a Skilled Nursing Facility and the facility believes that Medicare will no longer cover your stay and/or supplies. This is called a ‘Skilled Nursing Facility ABN.’ The facility will give you instructions on filling a ‘fast appeal.’ Sell your goodies DISCREET Ebay sales in your home ® TURN YOUR VALUABLES INTO CASH! Leslie Lerman-Feldman 917-856-7355 NST Resident MEADOW PARK REHABILITATION & HEALTH CARE CENTER REHABILITATION & HEALTH CARE CENTER Our Subacute Care is designed to handle rehabilitation and complex medical treatment for a diverse range of conditions including: Short-Term Rehab & Long-Term Care Prosthetic/Orthotic Services IV Therapy/TPN/Tracheotomy Palliative/Hospice Care Stroke/Cardiac Rehabilitation Speech Services Physical/Occupational Therapies Subacute Wound Care Services Pain Management Respiratory Services 78-10 164th Street Phone: 718-591-8300 Fresh Meadows, NY 11366 www.mprcare.com
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