It’s every patient’s worst nightmare: You undergo a complicated, expensive medical procedure, only to have your insurer deny your claim and refuse to pay, leaving you stuck with the bill. (Every patient’s second worst nightmare, by the way, is the one in which NBC decides not to cancel “Animal Practice.”)
Most people associate claim denials with profit-making private insurance companies, but Uncle Sam also plays the rejection game: As Encore contributor Anne Tergesen reports this week in the Wall Street Journal, Medicare rejected more than 107 million claims in 2010 alone–and one can only assume that the program will get more strict about what it pays for as it tries to control costs down the road. The silver lining: Folks who fight back and appeal their rejection have a surprisingly good shot at winning. Tergesen shows patients and their families how to fight the good fight here.