Navigating Medicare Denials & Appeals
If your Medicare Advantage plan or Part D plan denies coverage for a scan, surgery, or medication, you have legal rights to a fast, multi-level appeal process.
5 Levels of Medicare Appeal
- Level 1: Redetermination by the Plan: Submit your doctor's letter of medical necessity within 60 days.
- Level 2: Independent Review Entity (IRE): An independent organization reviews the denial if the plan upholds it.
- Level 3: Administrative Law Judge (ALJ) Hearing: Hearing before a federal judge for higher-cost claims.
- Level 4: Medicare Appeals Council Review: Review by the Departmental Appeals Board.
- Level 5: Federal District Court Judicial Review: Federal court appeal.
Expedited Review Rights
If waiting for a standard decision could seriously jeopardize your health or life during cancer treatment, your doctor can request an Expedited 72-Hour Appeal.
Free & Independent Counseling
Speak With a State Health Insurance Counselor (SHIP)
HIICAP (Health Insurance Information, Counseling and Assistance Program) provides free, unbiased, one-on-one Medicare counseling. SHIP counselors do not sell insurance or receive commissions.