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How To File a Medicare Appeal if Your Medicare Plan Doesn’t Cover Services or Items

A Medicare beneficiary takes notes on the Medicare appeals process in their notebook

It can be frustrating to receive a medical bill and find that Medicare or your Medicare plan didn’t cover something you thought it would. If you disagree with a coverage or payment decision by Medicare or your Medicare plan, you have the option to file an appeal. Here’s a guide to filing a Medicare appeal.

Tips to Help You Start the Medicare Appeals Process

Here are a few quick tips to help you get started on the Medicare appeals process:

  1. Gather all the necessary information

    If you decide to file a Medicare appeal, you’ll want to ask your doctor, healthcare provider, or supplier for any information that could help your case such as service or treatments received. You’ll also want to go over your plan details to gain a better understanding of your appeal rights and how the process works.

  2. Write it down

    You’ll want to fill out the appropriate appeals form, writing down the specific service or benefit you believe should be covered by Medicare. Be sure to include your Medicare number on all of the documents and provide your signature and telephone number. You’ll also want to make a copy of the forms you send in for your personal records.

  3. Send your appeal in

    Once you’ve gathered all of the information and documented it, you’ll want to send a copy of the forms you filled out, as well as any other documentation to support your appeal, to the appropriate Medicare contractor’s address. The amount of time it takes to get a response to your request can vary, but an expedited request could take 72 hours while a standard service request takes 30 days and payment request takes 60 calendar days.

What to Do if Your Medicare Appeal Was Denied

If you file a Medicare appeal and it is denied, it doesn’t mean you’re out of luck. The Medicare appeals process has five levels. If you disagree with a decision made at any level of the appeals process, you can generally go to the next level to make your claim. As you go through the process, you’ll receive instructions in the decision letter on how to move on to the next step of the process.

Is your current Medicare plan providing you adequate coverage?

Everyone has different priorities when choosing their Medicare coverage, but if you find that your Medicare plan doesn’t cover a lot of the services you need, it may be time to reevaluate your coverage. Our Medicare coverage quiz can help you figure out what type of plan might work for you and your situation. 

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