Medicare Newsletter - June 2019 - Week 1

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June 09, 2019
Medicare Newsletter - June 2019

Original Medicare and Medicare Advantage Standard Appeals

If you receive a denial from Original Medicare or your Medicare health or drug plan, you have the right to appeal. An appeal is a formal request for review of a decision made by your Original Medicare, Medicare Advantage, or Part D Plan. If you were denied coverage for a health service or item, you may appeal the decision.

Before you start an appeal, make sure you fully read all the letters and notices sent by Medicare and/or your plan. Call 1-800-MEDICARE or your private health or drug plan to learn why your coverage is being denied, if the information was not provided. There is more than one level of  appeal, and you have the right to continue appealing if you are not successful at the first level. Be aware that at each level, there is a separate time frame for when you must file the appeal and when you will receive a decision. Make sure to file each appeal in a timely manner. If there is a reason you cannot submit your appeal within the time frame, see whether you are eligible for a good cause extension. Otherwise your appeal may not be considered.

A Standard Appeal is an appeal of a denial for a health care service, item, or prescription drug that is covered by Medicare Part A or B. Keep in mind that you will follow a different appeals process if you are appealing the denial of a Part D-covered prescription drug or if you disagree with a hospital or skilled nursing facility's decision to discharge you or with a home health agency's or hospice's decision to end your care. 

To be continued next week...
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