Public Dollars Private Prerogatives Lessons From Medicare for National Health

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They certainly don't have to answer to anybody for their medical policy.
I know, for example, we had possibly as many as 10 clients who were being denied for one service related to anesthesia in upstate New York, and everywhere else in the country, every other Medi- care carrier, insurance company, was paying for the same service. Each time we had to take the claim through the appeals system until we got to an administrative law judge. They might have start- ed to correct that now, but that has
... been 3 or 4 years.
Chairman Wyden. I thmk that just hammers home why we need these kind of national standards, these screens that you are talking about. Because if you have a flawed medical necessity guideline and seniors and physicians don't end up being treated fairly, what you will have is people appealing and reappealing again and again and tremendous drain on resources while seniors don't get care and providers are Ms. Samiuan. Absolutely. Not only do we need these national policies, but we have to make sure that HCFA oversees that those pohcies are implemented correctly.


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