Don’t Miss the Opportunity to Request a Medicare Expedited Appeal
The problem facing many elderly and disabled individuals is how to maintain medically-necessary skilled nursing facility care when daily care is reduced to intermittent care. Without this daily care, many individuals cannot reach the level of independence they once enjoyed, and Medicare will no longer pay for room and board.
One solution is to exercise the right to a Medicare expedited appeal and obtain a physician recommendation for continued daily care. While easier said than done, health and independence are worth fighting for. To succeed, it’s important to know your rights, what to watch for, and how to respond.
First of all, before a reduction in care can take effect, the skilled nursing facility is required to provide a standard notice at least two days prior to the end of care. This notice will tell you the date coverage will end, the date the beneficiary’s financial liability begins, and the phone number to contact for an expedited appeal to overturn this decision.
The catch is you have until noon the day after receipt of this notice to appeal the reduction in care or you lose the right to an appeal. The burden is on you to watch for this notice and respond immediately. Remember, the facility must give you the notice, but they don’t have to draw your attention to it. All too often, these notices are quietly left at the beneficiary’s bedside or slipped into a pile of paperwork. If you don’t know your rights and watch for the notice, you can easily miss the appeals window.
While the appeals process is time consuming and tedious, the ultimate goal of rehabilitation and independent living is worth the effort. Our hope is that your awareness, diligence and perseverance will prevail, and we are here to lend support anytime you need it.
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Moschella & Winston has specialized in legal planning and protection for individuals and families for over 30 years, and our attorneys are experts in elder, disability and special needs law. Please contact us at info@moschellawinston.com or (617) 776-3300.