Rep. Larsen helped Orcas resident appeal Medicare claim

  • Sat Jul 6th, 2019 1:30am
  • News

Submitted by Rep. Rick Larsen, D-WA, 2nd District.

One of the most important and rewarding parts of being a member of Congress is supporting community members who need help navigating issues with federal agencies.

I am here to serve as a liaison between you and federal agencies. My office can support you to clarify determinations, track the progress of applications or appeals and work with federal agencies to address specific issues you are dealing with.

During the 115th Congress, between Jan. 3, 2017, and Jan. 3, 2019, my office helped 617 people who live in the Second District and recouped more than $2.77 million in federal benefits.

This recurring series will highlight some of the people across the district my office has supported. If you live in the Second District and need assistance with a federal agency, please contact my Everett District office at 425-252-3188 or visit my website

Helping James

James, an Orcas Island resident, reached out to my office for help after Medicare denied a claim.

James saw a doctor in Seattle for cancer treatment. After Medicare denied his claim, James reached out to my office to get an update on his appeal of the denial of coverage.

My office worked with the Centers for Medicare and Medicaid Services office in Seattle to track the first stage of James’ appeal and ensure he received a determination. During this first stage of appeal, the Medicare contractor made an unfavorable determination.

When James further appealed the determination, my office worked directly with staff at the Medicare contractor to track his request for reconsideration.

During the second appeal, the third-party review contractor found the physician had not properly educated James about the likelihood of Medicare coverage for the treatment he was given.

As a result, Medicare shifted the burden of payment from James to his physician.

James said of the process, “Congressman Larsen’s staff provided the needed information and support during the six months required to obtain a favorable result.”

One of my top priorities is to ensure constituents receive the support they need to navigate issues with federal agencies.

My office is here to support constituents who are looking for help with Medicare issues.