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Your Right to Appeal
If you have Medicare, you have certain guaranteed rights. One of these is the right to a fair process to Appeal decisions about health care payment or services. No matter what kind of Medicare plan you have, you may have the right to appeal these decisions.
You may appeal if
- a service or item you got isn't covered, and you think it should be.
- a service or item is denied, and you think it should be paid.
- you question the amount that Medicare paid.
You can find information on how to file an appeal in
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If you are in the Original Medicare Plan, you can request an appeal by following the instructions below:
- Circle the item(s) on the Medicare Summary Notice you disagree with and explain why you disagree.
- Sign the Medicare Summary Notice and provide your telephone number.
- Send the Medicare Summary Notice, or a copy, to the address in the "Appeals Information" section of the Medicare Summary Notice. You can also send any additional information you may have about your appeal.
You must file the appeal within 120 days of the date you receive the Medicare Summary Notice. If you want to file an appeal, make sure you read your Medicare Summary Notice carefully and follow the instructions.
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If you decide to file an Appeal , ask your doctor, health care provider or supplier for any information that may help your case. If you are in the Original Medicare Plan and you aren't sure if Medicare was billed for the services you got, call or write to the health care provider or supplier and ask for an itemized statement. This statement will list each Medicare item or service you got from them. You should get the statement within 30 days. Also, check your MSN to see if the service was billed to Medicare. If the service was not billed to Medicare, tell the health care provider or supplier to submit the bill to Medicare.
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If you are in the Original Medicare Plan, your health care provider or supplier may give you a notice called an "Advance Beneficiary Notice" that says Medicare probably (or certainly) won't pay some Medicare services in certain situations. This helps protect you from unexpected bills in some cases. If you still want to get the service, you will be asked to sign an agreement that you will pay for the service yourself if Medicare doesn't pay for it. You can still ask your health care provider or supplier to submit the bill to Medicare.
Medicare plans like HMOs, PPOs, and Medicare Prescription Drug Plan (Part D)s have other ways of providing this information. If you are in one of these Medicare plans, call your plan to find out if a service or item will be covered.
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(Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook 2007. This content may have been added upon by Q1Group LLC to include further examples, explanations, and links.)
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Last updated on: 07/05/2009
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Life Insurance plays an important role in your families financial stability.
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