Seventeen years after an accident left him paralyzed from the shoulders down, musician and music producer Scott Harding is no stranger to health insurance. He has extensive experience with the Medicare system and advocates for care that allows him to live and work independently.
But Medicare becomes more complex and less beneficiary-friendly every year. Rising health care costs, aggressive marketing, changing rules and coverage denials make it harder for people to access care.
Medicare becomes more complex and less beneficiary-friendly every year.
Last year, after a medical emergency that left Scott in the hospital and nursing facilities for months, he developed severe pressure injuries. His doctor prescribed him a specialized pressure-reducing bed that was supposed to be covered by Medicare as the durable medical equipment he needed to recover. But when Scott tried to get a bed through Medicare, he was denied even though he met the medical criteria. When he tried to find out why, he received only unclear explanations and confusing documents. When he tried to appeal the denial himself, he was paying nearly $3,900 a month out of pocket for the bed.
Fortunately, he was then referred to the Medicare Rights Center and our volunteers and social workers accepted his appeal and pursued it until the end. Allison, an experienced Medicare rights caseworker, reviewed Scott's records and accurately determined Medicare's requirements for his claim. She gathered the required documentation to prove that Scott qualified for a dedicated bed and that he had met all previous coverage requirements. For months, she worked directly with health insurance until her appeal was accepted and Scott's monthly out-of-pocket costs were reimbursed.
Our volunteers and social workers accepted his call and followed through.
“There are a lot of people who are being crushed by the system,” Scott said. “I've been in the system for 17 years and I've gotten pretty good at it, but this time it failed me. Medicare rights have been fighting for me.”
We get calls from people like Scott every day. Medicare beneficiaries come to us when they feel they have no choice, face unaffordable costs and denial they don’t know how to handle. For people like Scott, the Center for Medicare Rights serves as both a lifeline and a watchdog, providing one-on-one counseling to beneficiaries, training health care professionals and advocating for federal and state policies to expand Medicare. In the past year, we:
- More than 36,000 health insurance questions answered through our national helpline
- Secured $11 million in essential benefits for our clients
- Reaching millions of people through our education website Medicare Interactive
- Advocate for simplified Medicare enrollment and expanded Medicare savings plans
We believe that every person has the right to dignity and independence, and that health care is the foundation of this fundamental right. As challenges to affordable health care continue to grow, the Center for Medicare Rights will continue to work to make sure Medicare gets it right.
If you need Medicare help, Please call our helpline at 800-333-4114. To learn more about health insurance, visit health insurance interactive.
