From the Medicare Rights Center website as of June 18, 2008:
“History
The Medicare Rights Center National HMO Appeals Hotline, in operation since September 1997, provides direct assistance to older and disabled people who have had necessary care denied, reduced or terminated by their Medicare HMO. From September 1999 through August 2000, MRC's HMO Appeals Hotline handled 709 cases, secured much needed care for our clients, and saved them over $360,930 in out-of-pocket costs.
The Appeals Process
Our counselors guide callers through the HMO appeals process and, when necessary, intervene on their behalf with Medicare HMOs. After getting basic information about the problem, MRC staff either provide clients with information about how they can handle their own appeal or intervene directly on behalf of clients with their HMOs. In the typical case in which MRC intervenes on the client's behalf, hotline staff telephone the HMO to gather information and to advocate informally for our client.
When informal advocacy fails, MRC may write a letter to the HMO asking it to reconsider its denial. These letters contain facts, regulations and supporting documents pertaining to the case. MRC routinely sends a copy of this letter to the appropriate Health Care Financing Administration regional office, since we believe it is important to keep HCFA apprised of individual problems in a particular HMO as well as systemic problems that we observe when a large number of our callers run into the same difficulty.”
(The Health Care Financing Administration, or HCFA, became the Centers for Medicare and Medicaid Services in 2001)
One would think that an organization claiming to “institute more consumer protections for people enrolled in private Medicare plans”, would welcome well documented testimony about the wrongdoing perpetrated by a major private Medicare plan, with the blessing of the Centers for Medicare and Medicaid Services.
Furthermore, one would think that such an organization would post on its website, the criteria required in order to receive its assistance.
Neither is the case.
For at least a decade, my folks’ Medicare managed care HMO has referred its beneficiaries to the Medicare Rights Center for assistance in filing appeals. (This is true as of June 18, 2008.)
However, we have been repeatedly refused such assistance by MRC. The reasons have varied.
In 2003, the first time that I called MRC’s hotline on my folks’ behalf, a recording advised me to leave my name and number, and I received a phone call shortly after, but I was told by that individual that she did not know how MRC could help us. I had called MRC because my (late) mother’s Medicare provider had failed to provide her with medical services that her medical history, including the opinions of the specialists who had seen her, deemed necessary.
I called MRC again in mid 2004, on behalf of both my stepfather and mother for the same reason, and according to the Centers for Medicare and Medicaid Services website:
“Your Medicare Appeal Rights:
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.”
This time I was told via a phone call with MRC’s former Director of Client Services, Rina Kitazawa, that MRC only assists residents of New York State. I informed Kitazawa that in my stepfather’s case, I had found out that the Medicare provider had lied to us about the reason he had been denied a service, but she told me that there was nothing that she could to assist us.
Inexplicably, on or about the fall of 2004, I received a phone call from somebody at MRC saying that somebody was going to be getting in contact with me regarding my stepfather’s case. As it turned out, nobody contacted me.
I wrote a December 12, 2004, letter to Kitazawa asking her to clarify the requirements needed to receive assistance from MRC. I received a letter dated January 14, 2005 that was completely void of fact. Instead of answering my question, for some reason Kitazawa had decided to claim that MRC had carefully examined our case and had determined that we had nothing to appeal!
Earlier, I had provided Kitazawa with documents and testimony that showed that my stepfather’s surgeon (who was employed by the Medicare managed care provider) had requested that my stepfather be given acute physical therapy in my stepfather’s HMO network hospital (which was owned by the Medicare managed care provider) after my stepfather had neck surgery.
I had been told at that time that my stepfather had been evaluated to determine whether he was a candidate for acute physical therapy, and that it had been determined that he was not a candidate.
However, later I found out that he had never been evaluated because according to the Medicare managed care provider, the Medicare managed care HMO would not approve the service because it was “out of network”. (This was a service denial, and thus subject to appeal.) This information had been withheld from his medical records.In her letter to me, Kitazawa knowingly took a position based on the Medicare managed care provider’s deception. Kitazawa refused to acknowledge the documents that showed that a service had been denied.
I have had no further correspondence with Kitazawa. She is no longer at MRC.
The Medicare managed care HMO continued to list MRC as a resource for beneficiaries to use for assistance in filing appeals, and in late 2006, I spoke via a phone call with Paul Precht, MRC’s Director for Policy and Communications in Washington D.C.
Precht informed me that the Medicare managed care HMO was in error for referring its beneficiaries to MRC, but he refused to put that in writing, nor would he allow me to record our conversation.
There are many people, especially those affiliated with MRC, who believe that there is a statute of limitations regarding accountability. I have written to Robert Hayes, President and General Counsel MRC, requesting an explanation, and I have never received a response.
In June 2008, I phoned one of the foundations that grants funds to MRC. I spoke with Barbara Geenburg, President of The Philanthropic Group in New York. According to its website she “designed the grantmaking strategy for the Helen Andrus Benedict Foundation, and directs its grantmaking program.”
I started our conversation by telling her that I was concerned about the manner in which MRC advertised itself. Instead of responding to my concern directly, she asked me why I was talking about something that happened some years ago. I told her that it was because MRC was still allowing the HMO to use its name as a source for assistance. She then told me that she did not think that MRC could get the HMO to stop. I told her that that was ridiculous. She then asked me, as if she were his assistant, if I wanted Hayes to call me. I gave her my phone number, however, I still have not heard from him.
MRC’s promotion of itself has been very successful. Scores of other organizations have also referred me to MRC for assistance with appeals. Some individuals have insisted that I must be mistaken about MRC’s refusal to assist us. One of the reasons MRC’s lack of integrity is harmful is because there are so many people who believe its hype!
In our case, I wasted valuable time contacting and waiting for responses from MRC, because I believed their hype too. There is a need for legitimate resources to be made available to people like us.
The information that MRC offers via its website is available elsewhere on the Internet on sites such as those belonging to WebMD and CMS.
I believe that MRC’s principals hope to keep the donations and grant money coming in by continuing to make false claims about the scope of their assistance to Medicare and Medicare managed care HMO beneficiaries. There is no other reason for them not disclosing the limitations that they have personally disclosed to me.
(MRC’s most recent IRS 990 forms are available for free at GuideStar . Registration is required, but there is no cost to examine the forms.)
“History
The Medicare Rights Center National HMO Appeals Hotline, in operation since September 1997, provides direct assistance to older and disabled people who have had necessary care denied, reduced or terminated by their Medicare HMO. From September 1999 through August 2000, MRC's HMO Appeals Hotline handled 709 cases, secured much needed care for our clients, and saved them over $360,930 in out-of-pocket costs.
The Appeals Process
Our counselors guide callers through the HMO appeals process and, when necessary, intervene on their behalf with Medicare HMOs. After getting basic information about the problem, MRC staff either provide clients with information about how they can handle their own appeal or intervene directly on behalf of clients with their HMOs. In the typical case in which MRC intervenes on the client's behalf, hotline staff telephone the HMO to gather information and to advocate informally for our client.
When informal advocacy fails, MRC may write a letter to the HMO asking it to reconsider its denial. These letters contain facts, regulations and supporting documents pertaining to the case. MRC routinely sends a copy of this letter to the appropriate Health Care Financing Administration regional office, since we believe it is important to keep HCFA apprised of individual problems in a particular HMO as well as systemic problems that we observe when a large number of our callers run into the same difficulty.”
(The Health Care Financing Administration, or HCFA, became the Centers for Medicare and Medicaid Services in 2001)
One would think that an organization claiming to “institute more consumer protections for people enrolled in private Medicare plans”, would welcome well documented testimony about the wrongdoing perpetrated by a major private Medicare plan, with the blessing of the Centers for Medicare and Medicaid Services.
Furthermore, one would think that such an organization would post on its website, the criteria required in order to receive its assistance.
Neither is the case.
For at least a decade, my folks’ Medicare managed care HMO has referred its beneficiaries to the Medicare Rights Center for assistance in filing appeals. (This is true as of June 18, 2008.)
However, we have been repeatedly refused such assistance by MRC. The reasons have varied.
In 2003, the first time that I called MRC’s hotline on my folks’ behalf, a recording advised me to leave my name and number, and I received a phone call shortly after, but I was told by that individual that she did not know how MRC could help us. I had called MRC because my (late) mother’s Medicare provider had failed to provide her with medical services that her medical history, including the opinions of the specialists who had seen her, deemed necessary.
I called MRC again in mid 2004, on behalf of both my stepfather and mother for the same reason, and according to the Centers for Medicare and Medicaid Services website:
“Your Medicare Appeal Rights:
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.”
This time I was told via a phone call with MRC’s former Director of Client Services, Rina Kitazawa, that MRC only assists residents of New York State. I informed Kitazawa that in my stepfather’s case, I had found out that the Medicare provider had lied to us about the reason he had been denied a service, but she told me that there was nothing that she could to assist us.
Inexplicably, on or about the fall of 2004, I received a phone call from somebody at MRC saying that somebody was going to be getting in contact with me regarding my stepfather’s case. As it turned out, nobody contacted me.
I wrote a December 12, 2004, letter to Kitazawa asking her to clarify the requirements needed to receive assistance from MRC. I received a letter dated January 14, 2005 that was completely void of fact. Instead of answering my question, for some reason Kitazawa had decided to claim that MRC had carefully examined our case and had determined that we had nothing to appeal!
Earlier, I had provided Kitazawa with documents and testimony that showed that my stepfather’s surgeon (who was employed by the Medicare managed care provider) had requested that my stepfather be given acute physical therapy in my stepfather’s HMO network hospital (which was owned by the Medicare managed care provider) after my stepfather had neck surgery.
I had been told at that time that my stepfather had been evaluated to determine whether he was a candidate for acute physical therapy, and that it had been determined that he was not a candidate.
However, later I found out that he had never been evaluated because according to the Medicare managed care provider, the Medicare managed care HMO would not approve the service because it was “out of network”. (This was a service denial, and thus subject to appeal.) This information had been withheld from his medical records.In her letter to me, Kitazawa knowingly took a position based on the Medicare managed care provider’s deception. Kitazawa refused to acknowledge the documents that showed that a service had been denied.
I have had no further correspondence with Kitazawa. She is no longer at MRC.
The Medicare managed care HMO continued to list MRC as a resource for beneficiaries to use for assistance in filing appeals, and in late 2006, I spoke via a phone call with Paul Precht, MRC’s Director for Policy and Communications in Washington D.C.
Precht informed me that the Medicare managed care HMO was in error for referring its beneficiaries to MRC, but he refused to put that in writing, nor would he allow me to record our conversation.
There are many people, especially those affiliated with MRC, who believe that there is a statute of limitations regarding accountability. I have written to Robert Hayes, President and General Counsel MRC, requesting an explanation, and I have never received a response.
In June 2008, I phoned one of the foundations that grants funds to MRC. I spoke with Barbara Geenburg, President of The Philanthropic Group in New York. According to its website she “designed the grantmaking strategy for the Helen Andrus Benedict Foundation, and directs its grantmaking program.”
I started our conversation by telling her that I was concerned about the manner in which MRC advertised itself. Instead of responding to my concern directly, she asked me why I was talking about something that happened some years ago. I told her that it was because MRC was still allowing the HMO to use its name as a source for assistance. She then told me that she did not think that MRC could get the HMO to stop. I told her that that was ridiculous. She then asked me, as if she were his assistant, if I wanted Hayes to call me. I gave her my phone number, however, I still have not heard from him.
MRC’s promotion of itself has been very successful. Scores of other organizations have also referred me to MRC for assistance with appeals. Some individuals have insisted that I must be mistaken about MRC’s refusal to assist us. One of the reasons MRC’s lack of integrity is harmful is because there are so many people who believe its hype!
In our case, I wasted valuable time contacting and waiting for responses from MRC, because I believed their hype too. There is a need for legitimate resources to be made available to people like us.
The information that MRC offers via its website is available elsewhere on the Internet on sites such as those belonging to WebMD and CMS.
I believe that MRC’s principals hope to keep the donations and grant money coming in by continuing to make false claims about the scope of their assistance to Medicare and Medicare managed care HMO beneficiaries. There is no other reason for them not disclosing the limitations that they have personally disclosed to me.
(MRC’s most recent IRS 990 forms are available for free at GuideStar . Registration is required, but there is no cost to examine the forms.)
