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Help to eliminate the fear of a medical expense not covered by Medicare, along with helpful information and resources about the 72-hour Appeal rule.

Medicare And The 72-Hour Rule

I'm From The Government And I'm Here To Help You:

According to Ronald Reagan, these were the most frightening words we could hear.  It's still true, today.  With over 15 years working with the US Government, my experience tells me, help for you is not the purpose of any program or service.  So, how do we get the help we need from a program that took our money while we were working, and, now that we're dependent upon it, is threatening not to hold up its part of the bargain?  We'll try to answer that question, here.

Understanding Medicare Programs:

Virtually everyone in the US over the age of 65 has Medicare "help" whether they want it or not.  Only those with enough personal wealth to pay cash for medical services are able to escape this bureaucracy.  That number is shrinking rapidly, as Medicare mandates on the type and cost of services leave doctors no choice but to charge outrageous prices to anyone outside the system.  So, for those of us forced inside the system, how do we get the services our taxes supposedly paid for?  When you turn 65, your health insurance automatically takes second position to Medicare. 

You can choose to do this manually and have all the paperwork pass through you.  Or, your HMO (Health Maintenance Organization) can do it automatically, so, usually, all you would see are those bills not paid by either Medicare or your insurance.  Usually,  this goes off without a hitch, and with few, if any, bills you have to pay.  My sister died after accumulating about $ 1.5 Million in hospital bills.  Medicare and her insurance paid all but about $ 1,500.  As he saw the bills mounting up over the 6-9 months it takes to clear, my brother-in-law (Joe) went through some very serious anxiety.     

Grievances And The 72-hour Rule:

I think Joe could have appealed  those charges, but he was so happy that was all it was, he just signed the checks.  If you're in the same position, let the process work itself through Medicare, your insurance, and then from your doctor to you.  Though the Medicare Appeals And Grievances page is not completely clear (being written by government employees), it seems, if your Medicare is through any managed care insurance, like an HMO, most grievances will be submitted to your insurance company and they must answer you within 72 hours.  It isn't that clear for traditional Medicare, the Prescription Drug Plan, or other options.  It's interesting that I'm middle-aged and can't make sense of their explanation page...shows how much they care that seniors understand the program.   

Getting Real Help:

Here's a list of Medicare FAQ's, form to ask questions and information on people to help you.  For more sources of information, see our article on Medicare and Medicaid Abuse.  Really, the bottom line of the Medicare 72-hour rule is the question of how big a problem it is.  Just to file an appeal requires info from your doctor and all the applicable bills and letters, which will take far longer than 72 hours to give to them.  Unless we're talking major expenses, it may not be worth all the trouble.  If you are talking major expenses, it may be good to see an attorney and pay him to process your appeal.  Sometimes that gets attention that's missed when they know you're representing yourself.

Finally, we in the US are lucky enough to live in a country where we'll get necessary medical and assisted living care regardless of age and financial ability.  This doesn't mean we have nothing more to worry about.  This is a very frightening time of life, not knowing from one day to the next what will change, controlling less and less of your life.  Fortunately, we have someone who loves us and will help us get through.  That someone is God.  If you want help from God, click on God Help Me.

What experiences have you had with Medicare?

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