Does the Medicare Appeal Process Take Too Long?

Paula Oertel used an unapproved drugs for nine years to treat a brain tumor, and Medicare paid for it. When Oertel moved in 2007, she temporarily lost her Medicare coverage, and she went without treatment. During that time, two different drugs were approved to treat her condition. Once Oertel regained her Medicare coverage, both drugs were used, but neither worked. When the doctors tried to prescribe interferon, her claim was rejected by Medicare.

Oertal’s doctor spend the next few months making emails and calls in an attempt to raise some awareness, with the hopes of getting interferon approved by Medicare again. Last week, she finally got a call from her Congressman, who arranged for Oertel to appeal her Medicare claim with Maximus Federal Services. Maximus reviewed her case and found she was eligible to once again be put on interferon, with Medicare footing the bill.

The sad news is that it may be too late. During the time that Oertel was not on interferon, her tumor grew, and her new prescription might not be enough to stop its growth. It is unfortunate that Medicare took so long to review Oertel’s claim. At the same time, if it were not for Medicare, Oertel may have never been able to afford paying for interferon on her own.

Cancer patient to get her medication | Milwaukee Journal Sentinel

(photo: Rakka)

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