What does a Medicare Independent reviewer do for you?

An organization that has no affiliation with your Medicare health plan or Medicare Prescription Drug Plan (also known as an Independent Review Entity, or IRE). If you appeal your plan's payment or coverage decision, or if your plan fails to make a timely appeals decision, Medicare contracts with the IRE to review your case. A Medicare reviewer, such as an Independent Review Entity (IRE), is an organization that is contracted by Medicare to review appeals of denied claims and make an independent decision about whether the denial was appropriate.

If you disagree with a decision made by Medicare or your Medicare Advantage plan regarding your coverage, you have the right to appeal the decision. The appeals process has several levels, and if your claim is denied at any level, you can request a review by an IRE.

The IRE is an independent organization that is not affiliated with Medicare or your Medicare Advantage plan. Its role is to conduct an objective review of your appeal and make a final decision on whether to uphold or overturn the denial.

During the review process, you can provide additional documentation or information to support your appeal. The IRE will review your case and make a decision within a certain timeframe. If the IRE overturns the denial, Medicare or your Medicare Advantage plan must provide coverage for the service or item in question. If the IRE upholds the denial, you may have further appeal options, such as requesting a hearing with an Administrative Law Judge. It's important to note that the IRE process is only available for certain types of appeals, such as denials of coverage for medically necessary services. Other types of appeals, such as disputes over the amount Medicare paid for a service or item, may be handled through a different process.

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