5 things to know when filing an appeal

  1. If you decide to file an appeal, ask your doctor, health care provider, or supplier for any information that may help your case.
  2. If you think your health could be seriously harmed by waiting for a decision about a service, ask the plan for a fast decision. If the plan or doctor agrees, the plan must make a decision within 72 hours.
  3. The plan must tell you, in writing, how to appeal. After you file an appeal, the plan will review its decision. Then, if your plan doesn't decide in your favor, the appeal is reviewed by an independent organization that works for Medicare, not for the plan.
  4. If you believe you're being discharged from a hospital too soon, you have a right to immediate review by your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) . You'll be able to stay in the hospital at no charge while they review your case. The hospital can't force you to leave before the BFCC-QIO reaches a decision.
  5. You'll have the right to a fast-track appeals process when you disagree with a decision that you no longer need services you're getting from a skilled nursing facility, home health agency, or a comprehensive outpatient rehabilitation facility.

Contact your State Health Insurance Assistance Program (SHIP) if you need help filing an appeal.