June 18, 2019
Medicare Appeals: What to do if a Health Care Service or Item is Denied
If you receive a notice of denial from Medicare or your Medicare Advantage plan, you do have the right to appeal this decision. An appeal is a formal request for review of a decision made by Medicare or your Medicare Advantage plan. Be sure to always review your Medicare Summary Notice (MSN) to find out if Medicare has covered or denied the services or items you’ve received. You should receive your MSN in the mail quarterly, every three months, and it will contain a summary of the services or items that you received during the quarter. If you disagree with a decision that Medicare has made to not cover a particular item or service, the first step is to call your doctor or provider’s office and make sure that they did not make a mistake in filing the claim. If there was not a billing error, follow the instructions on your Medicare Summary Notice or Redetermination Request form.
If you need help interpreting your Medicare Summary Notice, or any other Medicare-related issues, you may contact the Senior Health Insurance Information Program at 1-800-224-6330. This is a FREE help line for Medicare recipients funded by the Arkansas Insurance Department.