Apr 29, 2020

5 things to know about the Medicare appeals process

If you disagree with a coverage or payment decision made by your Medicare health or prescription drug plan, you can file an appeal. Here are 5 key things to know about the Medicare appeals process:

  1. You can file an appeal if Medicare or your plan denies one of these:
    • Your request to get a health care service, item, or drug you think should be covered, provided, or continued.
    • Your request for payment for a health care service, item, or drug you already got.
    • Your request to change the amount you pay for a health care service, item or drug.
  2. If you decide to file an appeal:
    • Ask your doctor, health care provider, or supplier for any information that may help your case.
    • Contact your plan for information on your appeal rights.
  3. The Medicare appeals process has 5 levels. If you disagree with the decision made at any level, you can generally go to the next one. You'll get instructions in each decision letter on how to move to the next level.
  4. You have the right to a fast appeals process if you think your Medicare-covered services are ending too soon. Ask your provider for more information on how to file a fast appeal.
  5. You might need to send us some documents. If you do:
    • Make sure your Medicare Number is on all of them.
    • Keep a copy of everything you send for your records.

Get help and more information on filing an appeal.