Time to Appeal a Denial

I posted the following message to Senator Tom Harkin (chair) and Senator Patty Murry (member from WA) of the committee that oversees Medicare. If you agree with me, please send a post in support.

Webpage for Senator Harkin: http://www.harkin.senate.gov/


Please use your influence to extend the time patients have to appeal MedAdvantage (and Medicare Supplementary Insurance) denials. While the insurance provider is allowed 60 days to answer an appeal, the patient nominally gets only 30 days to generate it. However, the patient does not even get that full 30 days. The 30-day period begins on the day the denial is generated and ends on the day the insurance provider receives the appeal. I usually receive notification of the denial 5 to 10 days after its creation, due to the inefficiency of the United States Postal Service. And I must allow 10 days for the appeal to reach the insurance provider (without paying an extra fee for two-day delivery). That leaves me with only 10 days to process the appeal.

Most appeals require a thorough search of PubMed (National Library of Medicine) and other government sites. More often than not, the appeal also requires one or more trips to the local medical school library, for me the University of Washington. Once the data supporting the appeal has been gathered, several days are required to create and edit the appeal.

The most seriously ill patients are the most likely to have their claims denied. If a denial for chemotherapy does not occur during the treatment period, it will occur in the extended recovery period following treatment. It is extremely challenging for the patient to drag himself to the local medical school library when he is weak and nauseous from cancer-fighting drugs. And if the patient does not have the education and experience to generate his own appeals, he must drag himself to his healthcare professional in order to ask for assistance.

Please use your influence to extend the period for an appeal to 120 days. Allowing twice the period permitted insurance providers is reasonable, when one considers that patients are generally not professional, are not familiar with the insurer’s rules, are not familiar with the standards of care, but are seriously ill.