Medicare health plan appeals - Level 2: Review by an Independent Review Entity (IRE)

If your plan decides against your reconsideration, they must send you a notice that gives you the specific reason(s) for any full or partial denial.

You have the right to send an Independent Review Entity (IRE) information about your case. They must get this information 10 days after the date you get the IRE notice telling you they have your case file. The IRE’s address is listed on the notice.

How long it takes for the IRE to send you its decision in a written Reconsideration Determination depends on the type of request:

  • Standard redetermination decision—7 days
  • Fast redetermination decision—72 hours

You'll get a fast decision if the IRE determines that your life or health may be at risk by waiting for a standard decision.

The time to complete standard service and fast requests may be extended by up to 14 days if, for example, the IRE needs more information to make a decision about the case, and the extension is in your best interest.

If you disagree with the IRE's decision in level 2, you have 60 days from the date of the IRE's decision to request an Administrative Law Judge (ALJ) hearing.