Many people are caught up in situations where their Medicare benefits are denied. Most of them do not understand why Medicare denial of benefits takes place. The major reason why benefits could be denied is errors. The information provided in the claim should be correct and free of errors since an omission by the provider could make the claim be denied by Medicare. Insufficient information highlighting on why the service is necessary could also easily lead to benefits denial.
You could also face Medicare denial of benefits if the provider you are working with is not enrolled with Medicare. In short, any kind of error within your claim could lead to Medicare denial of benefits you are looking to find. However, it is possible to dispute such a denial using the right channel and still have the benefits dispatched to you.
When faced with Medicare denial of benefits and want to dispute the denial, the party denied the claim should make a point of having another contractor evaluate the decision. This is done through a request which must be submitted within the first 180 days after the denial. After the decision has been reviewed, the new contractor then sends the decision to party after which one can request for a hearing before a judge if the results are favorable.
It is important to note that there is a specific amount that can be disputed and not just any denial can be disputed. After the hearing, the decision can work to the beneficiary’s advantage or against. In case in turn to be unfavorable, he or she can then take request to take it before the Medicare Appeals Council which has the final decision in the case.