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How do I file Medicare Appeal?
5 Levels for Medicare Appeal: Level 1: Redetermination Request
There are 5 different levels that you can go if you want to file a Medicare appeal. Let’s see if we can make some sense of it together and this is all just straight from www.Medicare.gov. Every 3 months you get notification from Medicare it’s called your Medicare Summary Notice. This shows everything that they paid out on your behalf. This where you would see if you had anything that wasn’t covered. If you don’t agree with something in there, you have to file your claim with them. You can follow it on www.MyMedicare.gov. Watch your time frames, there’s always going to be limitations and everything’s in writing. So look at here there’s 3 different ways to file an appeal. You have to fill out this redetermination request form and send it to the Medicare contractor at the address that they show you they’re going to put everything in writing for you step-by-step so watch your details very carefully. Follow the instructions to the T. You’re going to send it to that company. Make sure you document everything and take copies. Appeal Level 1 is the Redetermination Request.
Level 2 Appeal: Qualified Independent Contractor
The 2nd level is going to go to a qualified independent contractor (QIC). This person didn’t take part in the 1st level and they will review your request for reconsideration to make a decision. Again, on that paperwork you’re going to see everything in writing on how to get to the next level if you don’t care for their answer. Look at the 2 ways on how to submit a reconsideration request.
The form is called the Medicare Reconsideration Request form. When sending anything to the Qualified Independent Contractor/QIC always include your Medicare number, the specific items. Document everything possible. This is really important. Be sure to explain why you think it should be paid. If you’ve someone that you appointed to help you, put that person’s name down and sign it. So that’s level 2.
Level 3 Appeal: Administrative Law Judge
Go on to level 3 if you’re not happy with the determination in level 2. This is going to be a hearing before an Administrative Law Judge. This is an actual lawyer and to get the hearing the amount of your case must meet a minimum amount. As of 2017 that minimal amount must be a $160. Then the ALJ will figure out if the case meets the minimum dollar amount and then you can combine claims to meet the dollar amount so that’s the good. So watch the directions on the Medicare reconsideration notice that you’ve got from the previous level. They’re always going to document it for you.
Fill out the request for the Medicare hearing by the Administrative Law Judge. Be sure to put your Medicare number, the details about the claim etc. Go to level 4 if you’re unhappy with level 3. The paperwork will document how to go to the next step. You have 60 days after you get the decision to request a review from Medicare Appeals Council. Be sure to watch your time frames.
Level 4 Appeal: Medicare Appeals Council
If you are unhappy with your previous appeals determination, you can go to the Medicare Appeals Court. Always follow the directions that they give you from once you got on level 3 and you must send the request of the address in the ALJ's hearing decision. Fill out “Request for Review of an Administrative Law Judge (ALJ) Medicare Decision/Dismissal Form”. Submit in writing again. Don’t forget the same information, the claim, why. Document everything you can, & put your Medicare number on it. Notice there is a phone number that you can call its 1-800 Medicare and if you have more questions about that whole appeals council the whole review here’s the information at the bottom of the screen here that’s level 4 and last but not the least is level 5.
Level 5 is Judicial Review by Federal Court.
This one you have to have a certain dollar amount to be eligible to go to Level 5. For 2017 the minimum dollar amount is $1560. You can combine the claims to meet this amount. Check out the documentation they provide for you in Level 4 to get to this level.
So that’s the appeals process: document everything, put your Medicare number on everything, make sure you make copies. You just have to stay organized with the whole thing but they give you 5 levels. We’re happy to help you with anything that we can. Our number is (888) 506-7510. If you have Medicare questions like so many folks who are confused by Medicare have a look at our 6-Part Medicare mini course. You’ll find that at www.GetMedicareSavings.com.