Has your Medicare plan unexpectedly denied coverage for a doctor visit, medical procedure, prescription medication, supply item or hospital stay? You have the right to appeal, and for that appeal to be decided quickly. At Twin City Underwriters, we advocate for our clients’ best interests, and do everything we can to help resolve Medicare concerns if and when they arise. However, some issues – such as a Medicare appeal – can require additional intervention beyond our ability.
To help you better understand the appeal process, we’re sharing a few tips for filing a Medicare appeal.
Tips for Filing a Medicare Appeal:
1. Look for appeal instructions from your Medicare plan. The plan is required to tell you, in writing, how to appeal. If you can’t find that information, contact the plan.
2. Gather all relevant information about the appointment, procedure or item for which you need coverage. Ask your health care provider or supplier for any additional information that could help to make your case.
3. Write your Medicare number on all documents you submit as part of your appeal, and keep a copy of everything you send in.
4. Someone else can file an appeal on your behalf. You’ll need to fill out an Appointment of Representative form or submit a written request along with your appeal. Visit Medicare.gov for more information on what to include in that request.
5. If you believe that your health could be harmed by waiting for a decision on your appeal, request a fast decision, and ask your doctor to sign off. The appeal must then be decided within 72 hours. In addition, if you believe that you’re being discharged from the hospital before it is safe or healthy to do so, you have the right to an immediate review.
6. The appeals process has five levels. If you are denied, the denial letter will include information on appealing to the next level. You may be able to request that your appeal be reviewed by an independent organization that works for Medicare, not for your specific plan.
Choosing a Medicare plan can be difficult, but by using the guidelines above you can narrow down your options. Working with an insurance broker can help cut through the noise – an insurance broker will do the legwork for you to find a plan that fits your individual needs. Schedule a one-on-one meeting with one of our insurance brokers to get your questions answered!
We offer a variety of Medicare information meetings as webinars each month. To join a meeting check out our event calendar here and use your new Zoom knowledge to take charge of your Medicare decision process. If you have any questions about signing into a Zoom webinar, please contact us for support. Try out a couple meetings until you are comfortable with online gatherings and soon you’ll be a meeting expert.