Thursday, June 15, 2006

Medicare Rejects your Claim? Appeal, and Chances are You Win!

Category: Elder Law, Financial Planning

What do you do when Medicare rejects your claim for benefits? Why appeal of course.

According to the Medicare Rights Center, a national nonprofit organization "Appealing is easy and most people win so it is worth your while to challenge a Medicare denial,". The denial of coverage may be due, for example, to a simple coding error in your doctor's office.

People have a strong chance of winning their Medicare appeal. According to Center, 80 percent of Medicare Part A appeals and 92 percent of Part B appeals turn out in favor of the person appealing.

The Medicare Rights Center offers the following tips to maximize your success when appealing your denial:
  • Write "Please Review" on the bottom of your Medicare Summary Notice (MSN), sign the back and send the original to the address listed on your MSN by certified mail or with delivery confirmation.
  • Include a letter explaining why the claim should be covered.
  • When possible, get a letter of support from your doctor or other health care provider explaining why the service was "medically necessary."
  • Save photocopies and records of all communications, whether written or oral, with Medicare concerning your denial.
  • Keep in mind that you only have up to 60 to 120 days from the date on the MSN (depending if you are in a private Medicare plan, like an HMO or a PPO) to submit an appeal.
Click here for more information from the official Medicare website, including appeals forms.


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