How Do I Dispute A Medicare Denial Of Benefits?



Redetermination Request

If you have received a denial of benefits from Medicare, then you have 120 days to submit a Redetermination Request form. You can download a copy of this form at the Medicare website. In this form, you will need to outline the reasons why the treatment is necessary and if possible, obtain a letter from your doctor stating why you need this treatment. Medicare will send you a written response of their decision within 60 days of receipt of this form.

Redetermination Request to the Qualified Independent Contractor

If you have received a denial after the first step, then you must submit another Redetermination Request Form but this time to the Qualified Independent Contractor (QIC) who evaluated your claim. This form must be submitted with any and all supporting documentation within 180 days of the initial redetermination decision. The QIC will send you a written response within 60 days of receipt.

Administrative Law Judge Hearing

If you are still being denied benefits and the amount in dispute is in excess of $130.00, then you can request a hearing before an Administrative Law Judge. A request for hearing must be made within 60 days of the date of the QIC denial and the Judge will make a decision within 90 days of the date of the hearing. You can also get the form to request a hearing on the Medicare website.

Review By Medicare Appeals Council

If you have received a denial from the QIC, then you must request a review by the Medicare Appeals Council within 60 days of the last decision. As with all of the above steps, this request must be in writing and you will receive instructions on how to do this on your Administrative Law Judge denial. You will receive a decision within 90 days.

Review By The Federal District Court

If you are still being denied, and the amount in dispute is in excess of $1,220.00, then you must request a review by the Federal District Court within 60 days of receipt of the last denial. The details on how to request a hearing from this court will be on your denial from the Medicare Appeals Council.



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