According to CMS:
You have the right to appeal any decision about your Medicare services. This is true whether you are in the Original Medicare Plan, a Medicare managed care plan, or a Medicare prescription drug plan. If Medicare does not pay for an item or service you have been given, or if you are not given an item or service you think you should get, you can appeal.
The following conversation took place several years ago. The issue had been that Advocate Health Care of Illinois, had stated that my stepfather had not been given a health care service that his surgeon had requested because he had been evaluated and had been found not to fit the medical criteria. At the time of this call, I had just found out that he had been denied the service because Advocate had claimed that the insurer had stated that the place of the service was "out of network". (I later found out that he had never been evaluated, I doubt that the insurer had made any such claim.)
The CMS employee refused to acknowledge the documents that I provided to him that clearly showed this, thus he allowed Advocate to dodge the CMS regulations, as we should have been notified of any denial in writing. We then could have filed an Appeal.
The following recording was made with the knowledge of the CMS employee, per Illinois law. However, he thinks that the law does not apply to him.
Who's on first? Hello, I must be going. In search of the sanity clause etc.
