Ideally, Medicare pays a portion for health care costs without having the person to do anything. But in reality, this may not always be the case. There are instances when you may find that Medicare failed to pay enough for the medicine, treatment, or a visit to the doctor. It may also happen that perhaps Medicare stopped paying for the services that it once covered. If this happens to you, and if you feel that an error has occurred, you can file an appeal. Doing so may seem intimidating but it would be worth it because in most cases, appeals are successful.
An appeal is an action that you can take if you disagree with a payment made by Medicare. You can appeal if your Medicare plan denies one of the following.
- Request for a prescription drug, item supply, health care service that you think you need to get.
- Request to change the amount that you have to pay for a health care supply, service, of prescription drug.
- Request for payment for a health care service, prescription drug, supply, or item that you got.
In addition, you may also file an appeal if your Medicare stopped providing or paying for all or just a part of a health care service, item, supply, prescription drug that you believe you still need.
Filing for a Medicare Claim
The process of filing a claim may vary depending on the type of plan that you have acquired. But the process of the appeal itself has five levels. Thus, if your plan has been denied, you will probably have additional opportunities to make your claim.
In the case that Medicare approves or deny payment, called as “initial determination”, you will get a record of it on the Medicare summary notice that you receive every three months. To file for an appeal, the following are the things that you have to do.
- Go over the notice and identify the items in question.
- List down the reasons why you are making the appeal. You can do this on a separate piece of paper or on the notice itself. You can also use the form available at cms.gov and file this with the billing company listed on the summary notice.
- Sign it and don’t forget to write down your telephone number as well as Medicare number. Acquire a copy of it.
- Send a copy to the contractor’s address of your Medicare. You can find this on the summary notice.
- Include other documentation that will support your appeal.
It is also important to note that you have to file your appeal within 120 days of the date when you received the summary notice. Moreover, you can also file a fast appeal if you think Medicare should continue paying for services that you are already receiving. Your healthcare provider should be responsible in providing you with a notice that has instructions on filing. Doing so will make the process of filing a claim a lot easier.