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Appealing for Care Page Highlights

Disability Appeals

Insurance Appeals

Medicare Appeals

Refusal of Suppliers to File Medicare Claims Is Illegal

Additional Websites Regarding Medicare and Disability






Appealing for Care: Insurance, Medicare, Disability

The information on this page has been supplied by:

Robert Weiss, M.S.
Lymphedema Treatment Advocate
Tel: 818-368-6340
Fax: 818-368-6432


Disability Appeals

Seven Mistakes to Avoid When Seeking Social Security Disability Benefits

Allsup outlines mis-steps that can be obstacles when applying for SSDI benefits.

People with severe disabilities know what it means to wait.  They wait for medical test results; they wait for doctors’ diagnoses and they wait for answers to their questions about the future.  Delays are typical for people filing for Social Security Disability Insurance (SSDI) benefits, but there are ways to avoid common mistakes that make the process even more difficult to navigate, according to AllsupFounded in 1984 and headquartered near St. Louis, Allsup represents people nationwide for their entitled SSDI benefits.

Two-thirds of all SSDI applicants will have their initial claim denied.  If they appeal, and even if they are successful, they will go through several additional steps and may wait two years or longer before they ever see a disability payment. There are some missteps, however, that can actually add time and increase the delay for an SSDI award, according to Allsup.

“Social Security disability payments are a significant, and often the sole, income source for millions of individuals with disabilities and their families,” said Edward Swierczek, senior claimant representative with Allsup. “Unfortunately, people with disabilities often make mistakes in applying for their SSDI benefitsThis may result in even more delays, which puts more stress on what could already be a precarious financial situation.”

To help educate claimants, Allsup provides the following information on seven common mistakes people make when filing for SSDI benefits.

 Seven Common Mistakes When Filing for SSDI

1. Going into the process uneducated.  Some people believe it’s just a matter of filling out a few forms, sending them in and waiting for their checks. They would be surprised to find out just how complicated the SSDI process really is.

The Social Security Administration follows a five-step sequential evaluation process to determine if an individual qualifies for disability benefits (, explained Edward Swierczek, including:

  1. You must not be gainfully employed, which is defined as earning $940 a month or more,

  2. Your condition is severe, meaning it interferes with basic activities of work,

  3. Your condition is on the Social Security Administration’s list of disabling conditions, or medically equals one of the disabling conditions on the list, and you will be disabled for more than 12 months,

  4. You are not able to do the work you had been doing before the impairment, and,

  5. You can’t perform any other type of work.

“You have to meet the first two criteria before the Social Security Administration will consider your claim,” said Swierczek, who has more than 30 years of experience helping individuals through the complexities of the SSDI application process.

 “If you’re a 40-year-old ironworker who hurt your back, the Social Security Administration may find that you are not disabled if you can do desk work. You may not think you can, but if you don’t provide compelling evidence why you can’t, they will deny your claim,” he said. 

2. Going through the SSDI process alone.  Individuals who apply for Social Security Disability Insurance benefits without representation are more likely to have their claim denied. (

“Working with government agencies and understanding the nuances of what’s needed to comply with the regulation isn’t something the average person is aware of,” said Allsup senior claimant representative David Bueltemann, who has successfully represented thousands of SSDI applicants.

“Just as people hire accountants to complete their tax returns and represent them before the Internal Revenue Service if they’re audited, individuals are recognizing they need representation when they go into the Social Security Disability Insurance process,” he added. 

3.  Underestimating the impact of your disability. Sometimes pride leads people to underplay the extent of their disabilities because they have endured a condition so long that they have learned how to cope with the stress of daily life. But many people underestimate how much their disability affects their day-to-day lives. A good example, Bueltemann explained, is a 50-year-old grandmother who tells the state Disability Determination Service (DDS) that she takes care of her grandchildren.

If the woman doesn’t explain that the children are teen-agers and self-sufficient, the DDS may deny her claim because it believes that she is capable of working in a day care center. 

4. Exaggerating the impact of your disability. On the other end of the spectrum are people who want to make their condition appear worse than it is. For example, a man who uses a cane at a hearing before an administrative law judge but doesn’t normally use a cane would be over-representing his condition. “If the judge asks to look at the cane and sees the tip is not worn, the claim is immediately suspect, even though the claimant may have had a legitimate case if he’d just stuck to the unexaggerated truth,” Swierczek explained. “It is important to elaborate, but not exaggerate.” 

5. Being vague about your work history. Knowing what the expectations are for your work, and showing accurately from the outset why you can’t perform this work any longer, is an essential part of qualifying for SSDI benefits.  

For example, Swierczek said, a service technician might be required to drive for extended periods as part of the job. “If your impairment means you can only drive for 10 minutes without experiencing extreme pain, yet your job requires you drive in 60-minute stretches, you need to make it clear on your disability application what the work expectations are and what your limitations are,” said Swierczek. 

“Otherwise, you may end up in double jeopardy: Your disability claim is rejected because the Social Security Administration believes you can still perform your work,” he said. “But you’re out of work because you really can’t meet the requirements of the job.” 

6. Missing the appeals deadline. The Social Security Administration denies more than 60 percent of all initial SSDI applications, but there is a formal appeals process with three levels. If you are rejected at any level, you have only 60 days to appeal to the next level. If you miss the deadline, you need to start the process from the  beginning. 

If you’ve applied on your own and received a denial, it’s not too late to choose an SSDI representative such as Allsup, to handle the appeal and continue with your case.  Taking this step may make the difference in experiencing further delays to receiving your SSDI benefits. 

7. Giving up. The process can be excruciatingly long and cumbersome.  Nearly 750,000 people are waiting for a hearing before an administrative law judge, which is only one level of the SSDI appeals process. For individuals already facing significant physical or mental disabilities, this delay can add to the difficulty. Bueltemann, however, is quick to point out that receiving SSDI is a benefit that individuals with disabilities and their families have earned, if they meet the SSDI requirements. An SSDI award also is essential in securing other forms of financial support, including Medicare benefits and retirement protection.  “It may not be as easy as it should be to receive your payments, but don’t give up,” Bueltemann said. “Make sure you have good representation and don’t lose hope that you can secure your benefits.”

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 Insurance Appeals


HELP IS AVAILABLE IN YOUR APPEAL from Bob Weiss, a lymphedema advocate with the National Lymphedema Network:

"I help patients appeal denial of compression bandages, garments and devices. It is a lengthy process, taking 1-4 years, with not at all an assured outcome, but it is worth the trouble since I am using the successful cases to convince CMS to change their interpretation of the Social Security Act and to cover lymphedema treatment materials.

I do not charge any fees for the work I do. I expect the patient, therapist or provider to appeal the first denial, and when that appeal is upheld (and it will be) then I will help writing the Redetermination Request.  For Medicare cases, when that is denied, I will ask to be designated the Authorized Representative and I will write and submit the Reconsideration Request for an "independent determination" by a Medicare Quality Independent Contractor.  I will at that time generate an evidence package for use at a Medicare Administrative Law Judge hearing. This is the first level of appeal at which we have a chance of winning the appeal and being reimbursed. Contact me when you are denied reimbursement."

Robert Weiss, M.S.
Lymphedema Treatment Advocate
Tel: 818-368-6340
Fax: 818-368-6432

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Medicare Appeals

Until Medicare and the healthcare insurance industry understands the vital role of compression therapy as the backbone of lymphedema treatment, and everyone has healthcare insurance, there will be a need for help in covering the costs of these items. I recently participated in on a CancerCare Telephone Education Workshop on "Medical Update on Metastatic Breast Cancer" and was gratified to hear Patricia Spicer, CancerCare Breast Cancer Program Coordinator announce that CancerCare offers limited financial help in obtaining lymphedema bandages and garments (for lymphedema resulting from cancer treatment of all sites, not just breast). Call 1-800-813-4673 or go to the CancerCare website for further information.

In the meantime, if you have been denied coverage or reimbursement for your compression bandages or garments within the last 45 days, contact me and let me help you with your appeal. I recently had my third Administrative Law Judge favorable determination and upset of a Medicare denial, and am looking for more cases to pursue--especially in the Central and Eastern U.S. No cost or risk to you.

Robert Weiss, M.S.
Lymphedema Treatment Advocate
Tel: 818-368-6340
Fax: 818-368-6432

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October 2, 2007

Here are my latest guidelines for making Medicare appeals of service denials for treatment of lymphedema. I am not trained in medical or legal matters and cannot give medical advice or legal advice. The following expresses my personal understanding of Medicare law as it applies to the treatment of lymphedema, and it deviates from the views of the Centers for Medicare and Medicaid Services (CMS), the government agency designated by Congress to administer the Medicare system. Differences are being resolved on a case-by-case basis by Administrative Law Judges (ALJs).


Medicare is administered by the Centers for Medicare and Medicaid Services (CMS) to interpret Titles XVIII and XIX of the Social Security Act (SSA) and to implement the requirements of the SSA through a series of publications. Local administration is through a network of Medicare Contractors selected by CMS who either use the national publications or create local policies further interpreting the national policy or creating policy when a national policy does not exist.

Every service covered by Medicare must be medically necessary and must fit into a ”benefit category”¯ defined in the SSA. A specific item is covered if it meets the criteria set up for the specific benefit category, and it is denied if it is deemed not to be medically required or if it does not meet the coverability requirements for its benefit category.


The approach I have taken in appealing Medicare denials of lymphedema treatment is to show that the treatment service or item are medically necessary, that is it is part of a medically recommended treatment guideline and is prescribed by the patient's physician, and that it falls into a benefit category covered by the Social Security Act.

Specifically, I show that manual lymph drainage (MLD) performed by a specially-trained therapist in accordance with a physician-approved treatment plan determines the frequency and duration of the clinical treatment. The policies on treatment duration established for rehabilitative therapy do not apply to this medical procedure, and that the length of the treatment is determined by medical necessity.

Furthermore, I show that compression bandages, garments and devices fall into the “prosthetic devices” benefit category defined by Ā§1861(s)(8) of the SSA.

CMS Publication 100-2, Chapter 15, Ā§120 defined a prosthetic device as follows:

General.-- Prosthetic devices (other than dental) which replace all or part of an internal body organ (including contiguous tissue), or replace all or part of the function of a permanently inoperative or malfunctioning internal body organ are covered when furnished on a physician's order.”

In this case the inoperative or malfunctioning internal body organ is the lymphatic system and the compression items replace all or part of its function. 

There are no Medicare coverage determinations or policies dealing with compression bandages, garments or devices used in the function of treating lymphedema, so Medicare Contractors (and healthcare insurers) select policies which deal with materials which look similar but are used in a different function, and apply the coverage criteria for the other use. They obviously fail and are denied. 

Compression bandages are denied for home use because the benefit criteria they are placed into is “surgical dressings”¯, which are non-durable supplies used in an in-patient procedure in conjunction with treatment of an open wound. This is hardly the function of a short-stretch bandage, tubular sleeve or gauze finger bandage in the treatment of lymphedema! My argument is that the assemblage of these diverse materials every night on the lymphedema patient's arm or leg is a prosthetic device which is assembled to the exact medical requirements at that time by a patient or an aide who has been instructed in the specific techniques. It makes no more sense to deny a bandage system because its components are not covered than it would be to deny a wheelchair because its wheels or axle are not separately covered. What matters is the function of this totality of parts in the treatment of lymphedema that determines coverability. 

Compression garments are frequently denied either because they “are not medically necessary” or because they do not meet the requirements of “secondary surgical dressings.”¯ The first issue is easy to address by showing that these are different from “support stockings”¯ which are worn as comfort or convenience items, not necessarily with physician's prescription. These are required for daily use as part of the medical standard of care of lymphedema. [reference to ISL, ACS, NLN consensus recommendations] 

The second argument is more difficult to counter since 2006, when CMS moved the coding of compression stockings from the prosthetic devices category with HCPCS codes Lxxxx to the surgical dressing category with HCPCS codes Axxxx.  The criteria for coverage of a compression stocking as a secondary surgical dressing is that it be used with one or more primary dressing in the treatment of an open venous stasis wound.  Denied! 

So my approach has been to show that compression garments and devices meet the prosthetic device requirements of the SSA, and are therefore not subject to the surgical dressing coverage criteria. So far four Medicare Administrative Law Judges have agreed and have ruled that the Medicare patients must be reimbursed for their garments (upper limbs and lower limbs). 

Robert Weiss, M.S.
Lymphedema Treatment Advocate
Tel: 818-368-6340
Fax: 818-368-6432

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Compression is the mainstay of lymphedema treatment and denial of the medical materials which enable the patient to treat their lymphedema is tantamount to denial of medical treatment. And this is a breach of the insurance contract.

Medicare offers five levels in the Part A and Part B appeals process. The levels, listed in order, are: 

  1. Redetermination by the Fiscal Intermediary (FI), Medicare Contractor or DMEPOS Contractor
  2. Reconsideration by a Medicare Qualified Independent Contractor (QIC)
  3. Hearing by an Administrative Law Judge (ALJ)
  4. Review by the Medicare Appeals Council (MAC) within the Departmental Appeals Board
  5. Judicial review in U.S. District Court

I have had success with the following arguments:

1. Lymphedema is a diagnosable medical condition, not a symptom. (The medical record should note the appropriate ICD-9-CM diagnostic code.) 

2. The recognized medical treatment protocol for lymphedema from all causes, primary and secondary is complex decongestive therapy, the backbone of which is daily compression.

3. The physician's prescription attests to medical necessity of compression materials for this patient. (The prescription must have the diagnosis of lymphedema with the appropriate ICD-9-CM diagnostic code.) 

4. Compression characteristics required for day and night are different, necessitating two different kinds of bandages/garments (i.e. elastic for active periods-daytime, exercise, and non-elastic for inactive periods-night time, watching TV, aircraft flights, etc.) 

5. Daily use and need for frequent washing necessitates two sets of bandages and garments, every 4-6 months as required by wear-out and changes in patient's condition and measurements. 

6. Compression when used to treat lymphedema meets the definition of "prosthetic devices and supplies" in Title XVIII section 1861(s)(8) of the Social Security Act. 

7. Compression bandages, garments and devices therefore are covered by Medicare and Medicaid as medically necessary prosthetic devices. They should also be covered in individual insurance contracts which include prosthetics and orthotics (not all contracts do). 

8. Therefore, denial of the bandages, garments or devices which are prescribed by your physician for the treatment of diagnosed lymphedema constitutes a breach of contract and law.


(courtesy of Medicare Rights Center "Dear Marcia" Column)

 Your appeals timeline depends on three different factors: 

  1. What type of Medicare you have

  2. How long ago the Medicare Summary Notice (MSN) was filed

  3. Why you were "too busy"

If you have traditional Medicare (Part B), your appeal must be submitted within 120 days of the date on the MSN denying coverage. 

If you receive your Medicare through a private plan, like an HMO or a PPO, you only have 60 days to submit your request for reconsideration. The plan then has 60 days to make a decision for post-service denials (but only 30 days for pre-service denials). 

If the plan upholds the denial, the case is forwarded to an independent reviewer called the Center for Health Dispute Resolution (CHDR). CHDR must also make a decision to uphold or overturn the HMO's decision within 30 days for care or 60 days for payment. For more information on CHDR, visit its web site listed in the Spotlight on Resources below. 

Medicare or your Medicare private plan (HMO or PPO) must accept a late filing of an appeal if you can show "good cause" of why you did not file an appeal on time. "Good cause" reasons are judged on a case-by-case basis. Therefore, there is no complete list of acceptable reasons for filing an appeal late, but some examples include the following: 

  • The coverage notice you are appealing was mailed to the wrong address;

  • A Medicare representative gave you incorrect information about the claim you are appealing;

  • You or a close family member you were caring for was ill, and you could not handle business matters;

  • The person you are helping appeal a claim is illiterate, does not speak English or could not otherwise read or understand the coverage  notice.

If you think you have a good reason for not appealing on time, send in your appeal with a clear explanation of why it is late.


I help patients appeal denial of compression bandages, garments and devices. It is a lengthy process, taking 1-4 years, with not at all an assured outcome, but it is worth the trouble since I am using the successful cases to convince CMS to change their interpretation of the Social Security Act and to cover lymphedema treatment materials.

I do not charge any fees for the work I do. I expect that the patient, therapist or provider to appeal the first denial, and when that appeal is upheld (and it will be) then I will help writing the Redetermination Request. For Medicare cases, when that is denied, I will ask to be designated the Authorized Representative and I will write and submit the Reconsideration Request for an "independent determination" by a Medicare Quality Independent Contractor. I will at that time generate an evidence package for use at a Medicare Administrative Law Judge hearing. This is the first level of appeal at which we have a chance of winning the appeal and being reimbursed. 

Contact me when you are denied reimbursement.

Robert Weiss, M.S.
Lymphedema Treatment Advocate
Tel: 818-368-6340
Fax: 818-368-6432

September 3, 2008

Dear Lymphedema list readers,

I'm passing this Medicare Rights Center (MRC) notice on for your information.

The MRC is one of the most active Medicare rights organizations that advocates for the patient/beneficiary. They are not associated with Medicare, and can help you in your Medicare problems. 

I consult with them when they receive inquiries on lymphedema claims, and you can continue to contact me either privately or through this list on your garment appeals. 

Robert Weiss, M.S.
Lymphedema Treatment Advocate
Tel: 818-368-6340
Fax: 818-368-6432

The Medicare Rights Center is pleased to announce that they will be hosting monthly free web seminars on important Medicare topics. The monthly seminars will be held on the second Thursday of each month.

To register for these seminars, please visit Medicare Rights Center - Webinars" Medicare Appeals." 

Whether you get your Medicare benefits through Original Medicare or through a Medicare private health plan, you have right to get the medical care and coverage to which you are entitled. By knowing what Medicare covers and how to exercise your rights, you can take steps to get the health care you need. 

To educate professionals, caregivers and people with Medicare about Medicare rights and appeals processes, the Medicare Rights Center will be providing a free educational web seminar that will explain: 

  • What is an appeal?
  • Why and how do you appeal if you have Original Medicare?
  • Why and how do you appeal if you have a Medicare private health plan?
  • Why and how do you appeal if you have a Medicare Part D plan?
  • How do you appeal a hospital discharge?
  • How do you appeal a termination or a reduction of care (home health, SNF, outpatient rehabilitation facility)?

When: The monthly seminars will be held on the second Thursday of each month 1:00 pm Eastern Time. (Presentations usually last for 90 minutes, including the Q&A session.)

How: All you need is a computer with an Internet connection at 56K or better and a phone (preferably with a high quality speaker). You will be viewing the visual portion of the presentation over the Internet and listening to the audio portion via a toll-free phone line.

Note: Registration for the live seminars is limited. If you are unable to participate in the live seminar, a free recording will be made available on the following Friday. Please check back at Medicare Rights Center - Medicare Basics  to access the recording.

To register for these seminars, please visit Medicare Rights Center - Medicare Basics 

You can access recordings of recent web seminars on the website at: Medicare Rights Center - Medicare Basics  

And, for those of you with questions about Medicare, we would like to share all of our online resources with you: 

  • To learn more about the ins and outs of Medicare, please visit Medicare Interactive Counselor, the Medicare Rights Center's online resource for independent information and expert advice on Medicare.
  • For helpful information on the Medicare prescription drug benefit (Part D), please visit Medicare Prescription Drug Coverage (Part D)
  • If you need help with an individual Medicare problem, please call our Consumer Hotline at 800-333-4114.
  • If you need to appeal your Medicare drug plan, please call our Appeals Hotline at 888-466-9050.

We hope you can join us for these informational seminar.

All the best,
The Web Seminar Team 

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Medicare has found a new method of denying covered compression therapy items without actually denying them.

Medicare Summary Notices are now noting "Medicare will process your first claim only. In the future you must use a Medicare-Enrolled supplier and provide the supplier identification number on

your claim." and "Medicare cannot process this claim as you were previously notified that you must use a supplier who has a Medicare supplier identification number."
If you plan to appeal the denial of compression bandage systems, garments or devices, it would be prudent for you to purchase them from an enrolled supplier. Since these items will be denied, the supplier will ask you to pay up front and sign an Advance Beneficiary Notice of Nonpayment (ABN) form signifying that you understand that Medicare may not reimburse you for the purchase. This gets the supplier off the hook when it is denied. The supplier is then obliged BY LAW to file the initial claim for you.
It seems that Medicare will process one claim and one claim only from a beneficiary who has purchased a medical item from a non-enrolled supplier or from the manufacturer. In this case the beneficiary files a Patient's Request for Medicare Payment and the claim is processed by hand, instead of by computer, and takes a longer time to process.
The following is a recent CMS clarification on participating and non-participating suppliers:
"**Updated February 10, 2009- Clarification from January's DMEPOS Special Open Door Forum. Participating Provider/Supplier and Accreditation requirements
Medicare enrolled participating providers and suppliers must always accept assignment. Assignment is an agreement between beneficiaries, their providers/suppliers, and Medicare where the beneficiary authorizes the provider/supplier to request direct Part B payment from Medicare for health care services, equipment, and supplies. When the provider/supplier agrees to (or is required by law to) accept assignment from Medicare, then the provider/supplier is prohibited from attempting to collect more than the applicable Medicare deductible and coinsurance amounts from the beneficiary, the beneficiary's other insurance, or anyone else. Providers/suppliers that enter into a Medicare Participating Physician or Supplier Agreement (OMB No.0938-0373) agree to accept the Medicare-approved amounts as payment in full for all Part B services and supplies. A beneficiary should only pay the 20% co-pay (and any remaining Part B deductible) when they receive their equipment or supplies or when the equipment is repaired.
A Medicare enrolled non-participating provider/supplier, can choose which services to accept assignment for (unless mandatory assignment applies to the service; e.g., for drugs or biologicals, ambulance services, etc.). Therefore, the provider's/supplier's charges for DME supplies may be higher than the Medicare approved amount and the beneficiary has to pay the entire charge for the Part B services and supplies at the time of service. (NOTE: Medicare's limiting charge does not apply to DME supplies.)
In either case, participating and non-participating, Medicare providers/suppliers must bill Medicare on behalf of the beneficiary and must be accredited by September 30, 2009 in order to retain their Medicare Part B billing privileges.

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Refusal of Suppliers to File Medicare Claims Is Illegal

I have been advising lymphedema patients to appeal every denial of reimbursement for the compression bandages and garments used in the treatment of their lymphedema. Some suppliers do not file claims, claiming that these items are not covered by Medicare.

This refusal is illegal since these items have been found to meet the coverage criteria for "prosthetic devices" by several Administrative Law Judges, and the decision that they are not covered is not a decision that a supplier can make. CMS has recently published a clarification of the rule that requires Medicare-enrolled Suppliers to file a claim on behalf of a Beneficiary. This educational article can be downloaded as follows:

Mandatory Claims Submission and its Enforcement

The Social Security Act (Section 1848(g)(4)) requires that claims be submitted for all Medicare patients for services rendered on or after September 1, 1990. This requirement applies to all physicians and suppliers who provide covered services to Medicare beneficiaries, and the requirement to submit Medicare claims does not mean physicians or suppliers must accept assignment.

Compliance to mandatory claim filing requirements is monitored by CMS, and violations of the requirement may be subject to a civil monetary penalty of up to $2,000 for each violation, a 10 percent reduction of a physician’s/supplier’s payment once the physician/supplier is eventually brought back into compliance, and/or Medicare program exclusion. Medicare beneficiaries may not be charged for preparing or filing a Medicare claim.

For the official requirements, see the following:

Social Security Act (Section 1848(g)(4)(A); "Physician Submission of Claims" at on the Internet.

Requirement to file claims – The Medicare Claims Processing Manual, Chapter 1, Section 70.8.8: on the CMS website.

Robert Weiss
Lymphedema Patient Advocate

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The above material is the undersigned's interpretation of Medicare policy and procedures. It is my opinion only and is not authorized or approved by Medicare. This information is not to be used for medical or legal purposes, and is offered only as an aid in navigating the Medicare labyrinth.
Robert Weiss
Lymphedema Patient Advocate


Additional Websites Regarding Medicare and Disability (general information) (practical and educational information)


Page Last Modified 09/29/2015