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EDWARD J. CRAIL v. COMMONWEALTH PENNSYLVANIA (07/14/80)

decided: July 14, 1980.

EDWARD J. CRAIL, PETITIONER
v.
COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, RESPONDENT



Appeal from the Order of the Department of Public Welfare in case of Appeal of Edward J. Crail, No. M-223 959-T.C.

COUNSEL

Eileen D. Yacknin, for petitioner.

Edward P. Carey, with him Bruce G. Baron, Assistant Attorney General, for respondent.

Judges Mencer, Blatt and MacPhail, sitting as a panel of three. Opinion by Judge MacPhail.

Author: Macphail

[ 53 Pa. Commw. Page 21]

On October 12, 1978, Edward J. Crail (Petitioner) filed an appeal from a finding, dated December 23, 1977, by the Allegheny County Board of Assistance (CBA), that his wife, Delores Crail, now deceased, was ineligible for medical assistance from October 18, 1977 to November 11, 1977, while she was a patient at Magee-Women's Hospital (Magee) in Pittsburgh. A fair hearing was held and the hearing examiner dismissed the appeal as untimely filed. Petitioner has appealed from the dismissal to this Court. We affirm.

Delores Crail was admitted to Magee on October 18, 1977. The record shows that, at the time of her admission, Magee phoned the CBA to determine whether Mrs. Crail was eligible for medical assistance and was told that she was eligible. In fact, Mrs. Crail's eligibility for medical assistance had expired on December 16, 1976 and a new application was needed to secure payment for the services rendered by Magee. No such application was completed, however, and Magee sent a billing request to CBA on December 22, 1977.

As a result of the billing request, CBA sent Forms PA 162 and 5M to Mrs. Crail (who had died on November 11, 1977) on December 23, 1977. Petitioner received these forms, but took no action until October 12, 1978.

[ 53 Pa. Commw. Page 22]

Form 5M contains the date of Mrs. Crail's admission to Magee, her name and address as patient, and a notation that she was ineligible for benefits because no medical assistance application had been completed.

Form PA 162 is a notice of ineligibility for medical assistance addressed to Mrs. Crail. It states as follows:

Medical Assistance Manual 127.84 requires that an application for Medical Assistance benefits is needed for MA services.

Since a Medical Assistance application has not been received for your recent hospitalization your eligibility for possible ...


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