Last issue, we told you about filing a complaint: Reporting your concerns with the quality of care you’ve received.
This time, we will focus on filing an appeal: Protesting a plan’s refusal to cover a service, supply or prescription and requesting your case be reviewed and reconsidered.
If you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or Medicare Prescription Drug Plan, here’s how you can file an appeal:
Ask your doctor, health care provider or supplier for any information that may help your case.
If you think your health could be seriously harmed by waiting for a decision about a service, ask for a fast decision. If the plan or doctor agrees, the plan must make a decision within 72 hours.
The plan must tell you, in writing, how to appeal. The plan will review its decision, and if it doesn't decide in your favor, the appeal is reviewed by an independent organization that works for Medicare.
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. You'll be able to stay in the hospital at no charge while they review your case.
You also 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.