Medicare Managed Care: Greater Oversight Needed to Protect Beneficiary Rights

摘要

Because the appeals process helps safeguard Medicare beneficiaries' right to211u001ecovered services from managed care plans, you asked us to assess the adequacy of 211u001ethe process, including the recently instituted expedited process. Specifically, 211u001eyou asked us to focus on the appeals process at the plan level, providing 211u001einformation on (1) the appeals process available to beneficiaries when managed 211u001ecare plans deny care or payment for services, (2) beneficiaries' use of the 211u001eappeals process and the extent to which they are informed of their appeal rights, 211u001eand (3) the Health Care Financing Administration's (HCFA) oversight of this 211u001eprocess. To conduct our review, we interviewed officials from HCFA; the Center 211u001efor Health Dispute Resolution (CHDR), HCFA's contractor that reviews plans' 211u001eappeal decisions; and selected managed care plans.