How Do I Appeal A Medicare Claim Denial?

Once your Medicare claim has been denied you should take immediate action to start the appeals process. There are three steps to the appeals process two months (120 days) to appeal a claim that was denied, but the sooner you begin the better.

Before you begin the appeals process there are a few things you should review

1.Make sure you know what your Medicare Policy covers. It is important to know what services and procedures are and are not covered in your plan.

2.Why was your claim denied? Be sure you understand why Medicare is saying they will not accept your claim.

3.Compare what is allowed in you Medicare policy to why Medicare has denied your claim.

The first step to appealing your Medicare Claim Denial is to obtain, fill out, and submit the Medicare Redetermination Request Form. This form needs to be submitted within 120 days from the date your claim decision was made, which can be found on your Medicare Summary Notice (MSN). You can easily find the Medicare Redetermination Request Form online by going to the Medicare website.

If your appeal is approved there are no more steps you need to take. However, if you first appeal is denied you then need to obtain and fill out the Medicare Reconsideration Request Form. The Reconsideration Request Form is to be submitted to the Qualified Independent Contractor that is assigned to your case. If your claim is accepted there are not further steps. This form must be submitted in 180 days.

The third and final step in appealing your denied Medicare claim is to request for Medicare Hearing by an Administrative Law Judge. In this process, you request a hearing by an Administrative Law Judge. You must request this within 60 days of the date of the Reconsideration decision. With this step of appeal the claim must be more than $120.

One Response to “How Do I Appeal A Medicare Claim Denial?”

  1. While looking at your website I noticed a problem with your first paragraph on the “how do I appeal” page.

    The problem, shown in quotes, below, is that two months is 60 days. 120 days is 4 months.

    “process two months (120 days) to appeal a claim that was denied, but the sooner you begin the better”

    Without going to the website, I cannot just yet quote the correct figure. I know this is a typo of some sort you guys can correct or expand upon if some additional information was accidently left out of the paragraph.

    I think your website is nice and will be using it as I have just been denied a claim of $3784 for an MRI that revealed (finally, after 20 plus years) what a problem I have really is!! Reason given was “not medically necessary.” The reference material they directed me to cites reasons for ordering an MRI and all match my situation as being payable by medicare.
    Thanks for the nice site and helpful info on your site. It has helped relieve some of the depression over facing destruction of my savings just to pay for a denied claim for a MRI that identified my problem. If I had this to do over again, I would opt for another 20 years of pain.