How to file an appeal if your Medicare Advantage Plan doesn’t cover an item or service
If you have a Medicare Advantage Plan, you know it covers a lot of items and services, like prescription drugs, diabetic test supplies, cardiovascular screenings, and hospital visits. But, what should you do if your plan won’t cost an item or service you need?
You have the right to ask your Medicare Advantage Plan to provide or pay for items or services you think should be covered, provided, or continued. To resolve these differences with your plan, learn how to file an appeal.
Here are 4 tips to help you get started:
- Get help: If you want help filing an appeal, contact your State Health Insurance Assistance Program (SHIP) or appoint a representative. Your representative could be a family member, friend, advocate, attorney, doctor, or someone else who will act on your behalf.
- Gather information: Ask your doctor, other health care providers, or supplier for any information that may help your case.
- Keep copies: Be sure to keep a copy of everything you send to your plan as part of your appeal.
- Start the process: Follow the directions in your plan’s initial denial notice and plan materials. You have 60 days from the date of the coverage determination. If you miss the deadline, you must provide a reason for filing late. See what information to include in your written request.
Once you start the appeals process, you can disagree with the decision made at any level of the process and can generally go to next level. Learn more about appeals in a Medicare Advantage Plan.
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