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WHEN 72-YEAR-OLD MRS. SMITH WENT TO THE

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When 72-year-old Mrs. Smith went to the emergency room complaining of heart palpitations and dizziness, she was terrified she was having a heart attack.

Fortunately, the tests showed it was not a heart attack but an episode of atrial fibrillation, a disturbance of heart rhythm she had experienced intermittently for years.Another big scare came several weeks later when Mrs. Smith received notice that Medicare would pay only $35 of her $150 bill for diagnostic tests. The "Explanation of Medicare Benefits" indicated that such tests could have been performed in a doctor's office, which would have lowered their cost; consequently, Medicare would reimburse the hospital for 80 percent of the "allowable charge" if the tests had been performed in a doctor's office.

Mrs. Smith contacted the Medicare Advocacy Project in Los Angeles. A counselor assisted her in filing an appeal. She submitted the necessary paperwork, including a notice from her doctor explaining that she had gone to the hospital for emergency treatment when her regular doctor was unavailable. Medicare reviewed her claim and agreed to pay an additional $60.

According to Melanie Lynch of MAP, Mrs. Smith's case is typical: 50 percent of individuals who appeal Medicare Part B (medical insurance) decisions win their claims.

You always have the right to appeal a decision, and it is often worth the effort if Medicare completely denies your claim or pays only a small fraction of it. Medicare typically approves 60-70 percent of each bill. It pays 80 percent of the charges approved.

The Medicare appeals process varies, depending on whether it is a Part A (hospital insurance) claim or a Part B claim. Part A appeals must be filed within 60 days after the initial decision, Part B claims within six months. Should you receive an unfavorable decision after filing an appeal, you can usually request additional hearings.

For more information and help with filing an appeal, call your local senior center or Area Agency on Aging for the phone number of the nearest Health Insurance Counseling and Advocacy Program. HICAP counselors provide free assistance with the appeals process.

QUESTION: My 53-year-old mother-in-law is suffering from Alzheimer's disease. My mother-in-law realizes what's happening intermittently, and we are saddened that her formerly razor-sharp mind is slowly deteriorating.

We are determined she should remain at home as long as possible. Do you have any helpful pointers?

ANSWER: The earliest onset of Alzheimer's disease is generally in the 40s, although most cases are reported in individuals age 75-plus. It is now the nation's fourth-leading cause of death among adults. Because it is a progressive illness, it is likely your mother-in-law's condition will worsen over time.

The following questions may be useful in helping determine her ability to be involved in activities:

-What is her attention span?

-How well can she judge safety factors?

-How intact is her short-term memory?

-How well can she follow directions?

-How much stress can she handle?

-How much strength and stamina will the activity require?

For more information and assistance, contact the Alzheimer's Disease and Related Disorders Association. For a referral to the nearest chapter, call 800-621-0379 (in Illinois, 800-572-6037).

Also, a number of good books have been written for families struggling with Alzheimer's disease. Particularly informative are "The 36-Hour Day" by Nancy Mace and Peter Rabin, "Another Name for Madness" by Marion Roach and "The Loss of Self" by Donna Cohen and Carl Eisdorfer.

QUESTION: I'm considering having cosmetic facial surgery to give me a more youthful look. I want to be sure I choose a qualified surgeon. Any suggestions?

ANSWER: Citing deceptive advertising, unqualified doctors and failed surgeries, patients and industry experts who testified at a congressional hearing in April underscored the need to be choosy when selecting a physician to perform cosmetic surgery. Guidelines to consider:

-Be aware that there are different kinds of board-certified doctors; some may be more qualified than others. Your best bet is to choose one certified in one of the 24 specialties recognized by the American Board of Medical Specialties, says Kathy Kuntzman of the American Medical Association. Such specialties include plastic surgery, dermatology and otolaryngology (ear, nose and throat). Ask your personal physician or a medical association for referrals.

-Recognize that board certification is only a benchmark of quality, not a guarantee. Given this, "it's incumbent on the patient to ask a whole lot of questions," says Kuntzman. Find out how long the physician has been performing plastic surgery and on what part of the body he or she typically works. Ask to speak with former patients and see their before-and-after photos.

-Ask about the operation's risks, benefits and follow-up procedures. No surgery, not even the relatively simple liposuction, is risk free.

-Evaluate the facility's capabilities as well as the provider's. Noting that cosmetic surgery is often done on an outpatient basis, Kuntzman advises consumers to find out what hospital they'll go to if the surgery is performed.

C) 1989 Washington Post Writers Group