Can You Appeal If Medicare Refuses To The Cover Care You Received?

Angela McCainby:


If your Medicare advantage is repealed, you can surely appeal for the same using the right professional. 

Having a Medicare advantage means that your healthcare provider will submit the claims directly to the concerned authorities for payment. However, if your claim has been rejected, then you can directly challenge the same using the aid of the best Florida Insurance Dispute Attorneys.

Why do you need Florida Insurance Dispute Attorneys?

In the USA, Medicare beneficiaries have the right to file an appeal for any denied claim. It is limited to six months of getting the rejection from the above authorities. The success rates for the appropriate claim are pegged at 75 percent (as per the 2018 report). It means that challenging the rejected claim can be a good idea and save you money on your treatment plan.

You can seek the aid of professional Florida Insurance Dispute Attorneys who, in turn, can help you to challenge the decision. They also help you to decide between appealing to the – 

  • National Medicare fee for service program (Parts A and B),
  • Your private Medicare health plan (Part C),
  • Medicare Prescription drug plan (Part D)

Some of the common situations that call for appealing for a claim 

  • If you have already availed of the services, medications, or needed supplies. For instance – the doctor prescribes a lab test, and then the same gets rejected.
  • The treating physician and surgeon had requested service or medication for your wellness. For instance – your doctor prescribes a piece of particular health equipment, but Medicare decides that the same is not necessary.
  • You or your doctor have requested a change in the price for the medication depending on a new treatment plan, especially when the older ones have failed. For instance – if a generic drug is not suitable for your condition and the doctor deems it fit to recommend a new (but expensive) treatment plan.

The process of appealing for reconsideration

The process of appeal is extremely different in the case of Medicare plans. There are five levels of the appeal process, and if you find that you have not received a satisfactory decision, you can continue to appeal at another level.

For instance – 

When you file an appeal under Medicare Part A or B (The original Medicare) – 

  • The bill is sent directly to Medicare
  • An appeal must be filed within 120 days of receipt of the rejection notice or the Medicare Summary Notice (MSN) stating the grounds of rejection of the claim
  • If you disagree with the MSN or the rejection claim, you can seek assistance from Florida Insurance Dispute Attorneys and file for an appeal

Three ways to file an initial appeal under the original Medicare plan – 

  • Fill in a Redetermination request form taking information from MSN and send it to the address mentioned in the same.
  • Follow the enclosed instructions on the MSN for filing the appeal without the form – 
    • Circle the claim that you disagree with
    • Use a separate paper to explain your case
    • List your address and details, MSN number, and sign it
    • Enclose any other information that may be of help to the claim
  • Send an appeal to the company that processes your claims.

Once you complete the above process, a decision will reach out to you in 60 days. However, if you submit additional information and post a delay, you can expect a delay in the response for an appeal.

Angela McCain

Angela is a senior editor at Dreniq News. She has written for many famous news agencies.

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