This request is a collaboration with Mike Gartner of Persius, an organization that provides free digital tools and data to help US consumers navigate issues with health insurance.
The Medicare program provides health insurance coverage to U.S. citizens and permanent residents over the age of 65, as well as to younger individuals with certain qualifying conditions. Medicare coverage is broken down into four categories:
- Part A (Hospital Insurance)
- Part B (Medicare Insurance)
- Part C (Medicare Advantage Plans)
- Part D (Drug Coverage)
When people covered by Medicare need medical items or services, a Medicare administrator — often an insurance company — makes a determination about whether the treatment or item is covered by their plan, and, if so, how much the plan will pay toward the cost.
Those who think that their coverage was inappropriately denied may contest the decision in a movement called an “appeal.” Medicare breaks this process into tiered appeals from Level 1 to Level 5.
Level 1 appeals are conducted by the individual’s health plan. If individuals are unhappy with the decision from a Level 1 appeal, they may request a Level 2 appeal, which is conducted by an independent organization.
We requested Level 2 appeal outcomes data because access to a unified dataset would allow for direct comparisons between a shared facet of different parts of the Medicare program, which has been largely impossible to date.
To get started with the data, please consult the Data Liberation Project’s introductory documentation.