
Quoting
Samson
Background: After my Dad exhausted his Medicare coverage for skilled nursing care Tricare became responsible. After months of review claiming "insufficient medical records/information" Tricare has decided to deny claims for my Dad's skilled nursing care with the explanation: "Not Medically Necessary".
1) Who is responsible for filing an appeal with Tricare? The nursing home or the family?
2) If the appeal is denied, is the patient responsible for paying for medical services deemed "not medically necessary?"
Thank you.