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Mr. Barker enjoys a comfortable

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Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included some services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him? Question 12Select one: a. You could suggest he call the doctor who performed the surgery to complain about the costs and ask for a discount on the charges. b. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state for Medicaid assistance. c. You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. d. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision.

d. You can offer to review the plan’s appeal process to help him ask the plan to review the coverage decision.

If Mr. Barker received charges in excess of his maximum out-of-pocket limit and he believes that some services and items should have been fully covered, he can appeal the coverage decision made by his Medicare Advantage plan. As his representative, you can assist him in understanding the plan’s appeal process and help him submit an appeal to the plan. The appeal process allows beneficiaries to challenge the plan’s decision and request a review to potentially resolve the issue and obtain the appropriate coverage and cost-sharing.