Medicare Advantage plans are regulated by the Centers for Medicare and Medicaid Services. Medicare Advantage HMOs have the right to deny services (specific medical procedures) in whole or in part. However, the beneficiaries have the right to file an appeal, expedited and otherwise, in response to any denial.
I have been the sole caregiver for my stepfather (and until her death in 2005, my mother) since 2000. Their Medicare Advantage (formerly Medicare + Choice) HMO has circumvented the appeals process on numerous occasions, in a variety of ways, and they have done so with the blessing of CMS.
I initially had sought assistance from my representatives in the House and Senate, but unfortunately the staff members with whom I spoke did not know much about Medicare managed care, and they were not interested in learning about it either. I supplied each of the offices with the documents that clearly illustrated the wrongdoing, but I do not know if anybody bothered to look at them. The apathy that I encountered was surreal. Several of those representatives eventually left office, and I contacted my new representatives. This time I made it clear that I was not seeking assistance, but that I merely wanted to make them aware of the issue. I would have been happy to hear an individual in a postion to really make a difference, acknowldege that they understood the problem and that they considered it to be unacceptable. To my amazement, I still ran into ignorance and apathy.
(It should be noted that I have copies of both the House and Senate Ethics Rules, and that I was not asking anybody to intervene in a judicial matter.)
I have been mocked by friends and strangers alike because of my attempt to affect change by attempting to have a dialogue with some of the individuals working on health policy for my representatives. It does not appear that the people with whom I have spoken have heard candidate Obama's message. Ironically, I am a resident of Illinois.
