Court and appeal decisions, explained

Real rulings from the Medicare Appeals Council — what was decided, and what it means for your appeal.

• J.S. v. Medica Health Care Plans (Docket No. M-12-1544)

  The enrollee requested a formulary exception for Percocet (oxycodone/acetaminophen). The ALJ denied the exception because the prescriber hadn't documented

• R.S. v. Connecticut General Life Insurance Co./Cigna Medicare Rx (Docket No. M-11-1799)

  The enrollee's Part D plan denied coverage of Geodon (ziprasidone) prescribed for an off-label use (mood and behavioral symptoms after a traumatic brain in