| Tue, Nov 03, 2015 @ 09:00 AM

The Medicare Appeal: Resources to Help Get the Process Started

Posted by Medicare Made Clear

medicare appealsIf you are a Medicare beneficiary and Medicare, your Medicare health plan, or your Medicare prescription drug plan has denied coverage or payment for a health care service, item, or prescription drug, you may have the right to file a Medicare appeal.

Below is a List of Several Medicare Appeals Resources.

If you have Original Medicare and you don’t agree with a Medicare decision, read about the five ways to file an appeal.

If you are receiving Medicare-covered services from a hospital, skilled nursing facility, home health agency, outpatient rehab facility or hospice and you think your services are ending too soon, learn how to file a fast appeal.

Your right to a fast appeal

How do I get a fast appeal in a hospital?

How do I get a fast appeal in a setting other than a hospital?

If you don’t agree with a Medicare prescription drug decision, learn how to file a Medicare prescription drug appeal.

Learn more about the Medicare appeals process through a video series created by The Centers for Medicare & Medicaid Services.

Medicare & You: Medicare Prescription Drug Plan appeals

Medicare & You: Overview of Appeals

Medicare & You: Medicare Advantage Plan Appeals

Medicare & You: Original Medicare Appeals

If you have coverage through Programs of All-inclusive Care for the Elderly (PACE), your appeal rights are different from those of a Medicare appeal. Find a PACE Organization near you to help file your appeal.

Contact your State Health Insurance Assistance Program (SHIP) if you need help filing an appeal. You can also appoint a representative, such as a family member, friend, advocate, attorney, doctor or someone else to file an appeal for you. Learn more.

For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.


5 Things to Know if You Want to Appeal a Payment Decision: Medicare.gov

Find the Medicare appeals forms that apply to your situation. Medicare.gov

Medicare Made Clear: Find information, tools and resources to help you make informed Medicare decisions.


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