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How to Appeal Denied Services in Original Medicare

How to Appeal Denied Services in Original Medicare

Original Medicare covers access to various health services that are enrolled in Medicare. However, in instances where you’re denied service, you can file for an appeal.

You can file for a Medicare Insurance appeal for the following situations.

  • Your payment request for a healthcare service you got is denied.
  • Your request for a coverage decision is denied.
  • You disagree with the Medicare payment decision.

To file an appeal, here are the steps you must follow.

  • Follow the appeal instructions in your MSN or Redetermination request form. Send your appeal to Medicare Administrative Contractor within 120 days of the date on your MSN. A decision will be made within 60 days.
  • If your appeal is approved, your service will be covered. If it’s not, file for a next-level appeal at Qualified Independent Contractor (QIC). Send your appeal within 180 days of your denial letter.
  • If again denied and the service that you’re appealing for is at least worth $170, send your appeal to the Office of Medicare Hearings and Appeals. File your appeal within 60 days of your denial letter.
  • You can appeal to the Council if your appeal is denied again, as long as it’s worth at least $170. Send your appeal within 60 days of receiving your denial letter. However, before proceeding, talk to a lawyer first.
  • Lastly, if your appeal is denied and the service you’re appealing for is at least worth $1,670, appeal to the Federal District Court within 60 days.

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