But Why? The right to know why Medicaid denied your claim

A recently filed lawsuit, Wells v. Kliebert, Secretary of the Louisiana DHH, 3:14-cv-00155, will be changing the face of Medicaid denial notices. Wells was filed against the Louisiana Department of Health and Human services alleging that the DHH systematically failed to give adequate notice and explanations of why Medicaid claims were denied. The suit alleged the lack of reasoning for the denials was a violation of the Due Process Clause of the U.S. Constitution. After the suit was preliminary certified as a class action, DHH and the class discussed a settlement for the matter. On October 24, 2014, The Middle District of Louisiana entered an order certifying the class in the suit and partially dismissing the suit, conditioned on the parties’ compliance with their agreed upon settlement.

The settlement agreed to by the parties requires notices of denials to state clear reasons in plain language and requires notices of denials to include what additional information would have garnered an approval. Also, the notice of denial has to include any reasons that might be raised at later hearings discussing the denial. Yet, the settlement stipulations are only mandatory for 5 years. Medicaid recipients can only hope that such positive changes in the claims process become permanent.

Written by: Danielle L. Borel