How do I file a Medicare service appeal?

If you disagree with a decision made by Medicare regarding your coverage or payment for a service, you have the right to file an appeal. Here are the steps to file a Medicare appeal:

Review the decision: You should receive a notice explaining the decision and why it was made. Review this notice carefully to understand why Medicare denied coverage or payment for a service.

Determine the level of appeal: There are five levels of appeal for Medicare. The level you choose depends on the type of decision being appealed. The five levels are:

• Redetermination
• Reconsideration
• Administrative Law Judge Hearing
• Medicare Appeals Council Review
• Judicial Review

1. Complete the appropriate form: To file an appeal, you must complete the appropriate form for the level of appeal you have chosen. You can find the forms on the Medicare website or by calling 1-800-MEDICARE.

2. Submit the form: Once you have completed the form, submit it to the appropriate entity based on the level of appeal you have chosen. The entity to submit the form to will be listed on the form.

3. Gather supporting documentation: It is important to gather any supporting documentation related to the service or decision being appealed. This documentation may include medical records, bills, and other information related to the service.

4. Wait for a decision: After you file an appeal, you will receive a notice of the decision at each level of appeal. Be sure to review the notice carefully and follow any instructions provided. If you need assistance with the appeals process, you can contact your State Health Insurance Assistance Program (SHIP) or a Medicare representative at 1-800-MEDICARE.

MedHelpCenter.us recommends that you call the Senior Health Insurance Agency at 813-592-8568 for further explanation.