HMO Hotline               

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.

Interesting Cases

Each month, MRC compiles Interesting cases that represent systemic problems in Medicare.

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