Medicare Claim Appeal - AAA Scan

[somarco]

When a consumer files an appeal with Medicare what should they do in the interim, while waiting on Medicare to approve or deny the appeal?

Under certain conditions, Medicare allows a one time only AAA scan, paid under Part B, no deductible.

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/MM5235.pdf

When Medicare reviewed the claim the Part B deductible was applied. Provider says Medicare decision is final. Provider refuses to refile the claim and suggested patient appeal to Medicare.

The appeal was filed with Medicare a month ago.

Is the patient expected to pay the balance the provider has billed and then get a reimbursement when Medicare approves the appeal?

I am told that Medicare is two years behind in reviewing appeals.

HHS Proposes To Streamline Medicare Appeals Process | Kaiser Health News

 

[ICACharleston]

This won't be much help but I'll tell you anyway. When I began on Medicare, my doc flagged me for the Aortic Abdominal Aneurysm screening. I had it done and got a 30 or 35 dollar "facility bill". I went round and round with the facility and Medicare and they all insisted I owed the money, tho all the information I had said it was to be paid at 100%, no copays. I finally got tired of hassling and put a check in the mail. That afternoon Medicare called me to tell me I was right and didn't owe the fee.

 

[AllyriaRedbird]

oof da! It figures.

Most seniors hate to have bills hanging out there unpaid, so I would think most will pay it and then forget they deserve a refund from the appeal.

No offense to seniors who happen to be agents, of course.