Initiating an appeal is your right whenever you object to a resolution regarding your Medicare coverage or a payment verdict by Medicare or your Medicare insurance plan.
For instance, you’re entitled to file an appeal in situations where Medicare or your plan refuses:
• A plea for a healthcare service, provision, piece of equipment, or medication that you believe should be financed by Medicare.
• A plea for remittance for a healthcare service, provision, piece of equipment, or medication you’ve already received.
• A plea to revise your financial responsibility for a healthcare service, provision, piece of equipment, or medication.
In case you are enrolled in Original Medicare, review your “Medicare Summary Notice” (MSN) as a first step. Your appeal must be lodged by the deadline specified in the MSN. Even if the deadline has passed, it might be possible to submit an appeal and receive a verdict if you can demonstrate a valid reason for the delay.
Should you be covered under a Medicare Advantage Plan, you would initiate the appeals procedure via your insurance plan. Adhere to the instructions in your plan’s rejection notice and the guidelines provided in the plan’s documents.
