With the right Medicare plan and supplements, getting health care coverage should be easy. If you’ve ever had a claim denied, however, you know that Medicare doesn’t always work that smoothly. Find out how to file a Medicare claim and navigate the appeals process successfully.
You can file an appeal when you don’t agree with a coverage or payment decision that Medicare makes in relation to Part A, Part B, Part C, or Part D. You have the right to appeal if you encounter one of the following scenarios:
If you have Original Medicare (Part A and Part B), you’ll get notice of a denial of coverage through your quarterly Medicare Summary Notice (MSN). You can file an initial appeal within 120 days of receiving the MSN, but in most cases, you’ll want to do so as soon as possible. Whether you’re awaiting Medicare’s decision before proceeding with a service or you need to lower your out-of-pocket costs for a supply you’ve already received, it’s in your best interest to start the Medicare appeals process as soon as possible.
The Medicare appeals process for Part A and Part B has multiple steps. You may receive a satisfactory decision after the first step, but if you don’t, you’ll need to pursue your appeal for as long as necessary until you get the decision you deserve.
If you need to file an appeal for Medicare Part C or Part D, keep in mind that the process may have fewer steps. Always contact your plan to confirm the timeline, the process, and how to submit your appeal.
The appeals process for Original Medicare is relatively transparent, and your plan is required to tell you how to file an appeal. While the process can take up to 14 days, you may have the right to request a faster decision. For instance, if waiting for an appeal will put your health in serious jeopardy, you can request an answer within 72 hours.
Whether you’re on the standard schedule or you can use the fast-track appeals process, you will either file a Redetermination Request Form or use the following steps to start the first level of a Medicare appeal.
Getting the health care coverage you need should be straightforward, but you’re bound to encounter a few bumps in the road. Now that you know how to appeal a Medicare decision successfully, share this article with family and friends so they understand how to file a claim too.
Published: December 16, 2019