A new federal rule keeps Medicare recipients in the dark about their coverage.
George Lirot is 71-years old, uses a wheelchair, suffers from cirrhosis of the liver, depressive disorder, and non-insulin dependent diabetes. His mental status is “oriented, forgetful and depressed,” according to court documents.He is on Medicare. The government sends him lots of paperwork. Because of his reduced capacity, he appointed a representative who works for the Center for Medicare Advocacy. In the past, any initial denials of coverage would be sent to the representative, so she could appeal the decisions and protect Lirot’s due process rights.Not anymore. Under a new rule that went into effect May 1, appointed representatives will no longer be sent initial determinations for their clients. The federal Department of Health and Human Services made the decision based on cost and privacy concerns.So CMA, a Willimantic-based group, filed a class action suit in U.S. District Court earlier this month.“This is one of those issues that has almost no sex appeal but that has a terrible impact on people trying to navigate the maze of the Medicare system,” said Gill Deford, an attorney with the Center for Medicare Advocacy in Connecticut who represents the plaintiffs. “If beneficiaries don’t know their claim has been denied, they can’t protect their rights. Sending a copy of the notice to the representative is the only way to guarantee that they don’t lose their right to review.“The class action suit challenges HHS on due process grounds and seeks a permanent injunction which would bar the agency from instituting the new rule. An HHS spokesman refused to comment, saying the department never speaks to pending litigation.