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Medicare Part D patients now have detailed instructions on how to appeal decisions.
If Medicare Part D patients are upset because their plan doesn't pay for a drug they need, they now have detailed instructions on how to appeal the decision. The process is laid out in the March 23 Federal Register, http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/2007/E7-5304.htm.
In essence they can ask for a reconsideration by the plan and subsequently, by an independent review group, an administrative law judge, and finally by the Medicare Appeals Council (MAC). If all these steps fail, they can file a civil action in federal district court. The rule also spells out who may refer cases to the MAC and the standards of referral.