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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