How Do I Appeal a Medicare Enrollment Rejection?

Before one is able to benefit from Medicare, he/she has to enroll to ensure they are eligible for it. After the application process, the physician or provider can then bill Medicare for a person’s medical bills. However, it is not always a guarantee that all people who apply will automatically be eligible for it. There are cases where these applications are rejected, and this could cause catastrophic financial problems to the caregivers. Having seen this, Congress enacted the enrollment appeals provisions of the Medicare Prescription Drug, Modernization and Improvement Act of 2003. Under this act, one has the right to appeal a Medicare enrollment rejection. It is important to note that before taking any action in a civil court, all other options must be explored.

Review Reasons For Denial

Whenever there is a Medicare enrollment rejection, a letter is sent to the applicant giving reasons why the application was rejected. It is important for the applicant to review these reasons first. The letter also indicates a time within which one can appeal a Medicare enrollment rejection, which is usually 60 days from the postmark date marked on the revocation or denial letter. Failure to do so will mean one has forfeited his/her right to appeal. After this, you must request reconsideration from the Medicare giver.

File Hearing Requests

After filing the reconsideration request and it is denied, one can then request a hearing from an Administrative Law Judge of the Departmental Appeals Board. This also has to be done within 60 days of receiving the reconsideration letter, otherwise the right to appeal is wavered. If you receive an unfavorable response from the ALJ, then request for an appearance before the Departmental Appeals Board. Once again, it is possible to get an unfavorable response from the DAB, in which case you can now file a suit in a federal district court.

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