If your Medicare drug plan decides against you in level 1, it will send you a written decision. If you disagree with the plan's redetermination, you can request a standard or fast reconsideration by an Independent Review Entity (IRE). Follow the directions in the plan’s "Redetermination Notice." If your plan issues an unfavorable redetermination, it should also send you a "Request for Reconsideration" form you can use to ask for a reconsideration.
Note
If you want your doctor, other prescriber, or another person to request a reconsideration from the IRE for you, you’ll need to appoint a representative and submit an "Appointment of Representative" form or other documentation to show that person may act on your behalf.
How long it takes the IRE to send you its decision in a written "Reconsideration Notice" depends on the type of request:
- Standard redetermination decision—7 days
- Fast redetermination decision—72 hours
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.
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