Appeal, Appeal, Appeal Medicare Denials

“Appeal, appeal, appeal,” is the advice from Joe Baker of the Medicare Rights Center. He says many of us are reluctant to appeal when an Medicare insurer denies something, and that’s a big mistake.

Only 1-3 percent of people who are denied coverage for a medication or a medical service appeal the decision. But more than 60 percent of those who do appeal get what they want.

The Medicare Rights Center’s national helpline deals with the problems people encounter with the Medicare system or their insurers. Now a new report from the group analyzes the complaints and finds that, among other issues, denials for prescription drugs are a consistent problem for those of us who have Medicare.

Courtesy Wikimedia
Courtesy Wikimedia


These medication denials are particularly frustrating because a pharmacist can’t tell you why you were denied. You’re likely to get a slip of paper that says you’ve been denied and should appeal to the insurance company.

That means you leave the pharmacy without the medication. You go home and call in and then wait for a written explanation via email, or regular mail.

In the meantime, you don’t have the medication. Baker says it’s a problem because, “You are not on the medication that the doctor thinks you should be taking immediately.”

watchmoreFind out How to Appeal


Proposing Changing

The Medicare Rights Center’s report proposes a rule change that would allow the pharmacist, with your permission, to call your doctor to see if there is another prescription medication that the insurer is likely to approve.

Streamlining Appeals

The report also recommends that the Centers for Medicare and Medicaid Services (CMS) streamline the appeals process.


Confusion about when to enroll in Medicare and penalties for late enrollment is another big issue for people just entering the Medicare world.

We continue to report about this issue because it’s a big one for Baby Boomers. I wrote about my problem with the transition to Part B in Medicare Catch 22.

We all get Medicare Part A when we turn 65 and many of us put off getting Part B. That’s okay, if we’re still working and have full-time healthcare coverage.

But if you are retired, have Cobra and are not going to work full-time, you have to sign up for Part B right away. Medicare becomes your primary insurer.  If you don’t there’s a penalty and you’ll pay it every month for the rest of your Medicare life.

Often people get the wrong information and guidance from their employers about the Medicare rules and they still have to pay the penalty. Baker and the Medicare Rights Center are lobbying for reform that will require a change in the initial enrollment period and an active campaign to get the word out to those just turning 65.

We explain it all in our video Baby Boomers, Medicare and Costly Mistakes.

We have a lot more about choosing Medicare plans.

watchmore   Figuring Out Medicare Choices

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Barbara Nevins Taylor

As the winner of 22 Emmy Awards and a slew of journalism honors and awards, I created to give you the straight story about complicated stuff. Tell us what you want to know and we'll get you the answers.