PATIENT BENEFITS
Posted by admin on November 16th, 2009In most jurisdictions, older patients are eligible for a range of age-based and needs-based services. In every state, the elderly are eligible for Medicare (see FINANCING HEALTH CARE in Ch. 110 and Ch. 114). The type of physician and hospital visits and the range of services (ie, eyeglasses, medications, hearing aids) that Medicare will cover changes regularly with new statutory and regulatory amendments. Phy¬sicians should know basic Medicare rules, have materials available that describe the range and extent of benefits, and be able to refer patients to knowledgeable legal and social service resources for further counsel¬ing and support. When a patient’s Medicare claim is denied, the deci¬sion can often be reversed by a prompt individual challenge supported by an appeal in a fair hearing administrative forum. In this administra¬tive procedure, the insurance company handling Medicare claims re¬views the case. If unsatisfied with the outcome of that review, the pa¬tient has a right to a hearing before a judge.
Poor elderly patients may be entitled to further medical benefits under Medicaid. Only about one third of elderly patients are poor enough to qualify; the exact income and resource levels that qualify a patient for Medicaid vary among states. State departments of social services, local Medicaid offices, and legal services for the elderly or the poor are good sources of information, materials, support, and individ¬ual representation.
Also, many states and localities have a bewildering array of special benefits and programs for the elderly, ranging from subsidies for trans¬portation, housing, heating, telephone, and food expenses to discounts at movies. Health care workers are responsible for educating elderly patients about and providing access to benefits and entitlements that may be important to their physical and mental health. Physicians should not attempt to be lawyers, but they should develop an expanded definition of care that includes increased sensitivity to the legal risks of being old and increased knowledge of services available to mitigate those risks.
