What Are Some Tips For Making A Strong Appeal?Below are some general rules to follow when appealing the denial of a health service or item:

  • Try to understand the reason that your plan is denying coverage for your health service or item.
    • Address any relevant coverage rules in your appeal letter, and encourage your doctor to do the same.
    • If you need assistance understanding the coverage rules surrounding the service or item in question, you can contact your State Health Insurance Assistance Plan (SHIP) for assistance by calling 877-839-2675 or visiting www.shiptacenter.org.
  • Keep good records of all your communications throughout the appeals process. Some ways to do this are:
    • Submit your requests in writing.
    • Keep proof of when you sent your appeal.
    • Keep all fax transmission reports, mail information by certified mail, or return receipts.
    • Write down details about phone calls regarding your appeal. This includes what you discussed, who you spoke to, and the date and time of the call.
  • Meet the deadlines. If you are unable to meet specified deadlines, request a good cause extension (see When and How Should I Request a Good Cause Extension?).
  • If you think you need help appealing, you can appoint a representative. The representative can be a friend, family member, doctor, or lawyer.

Read Next: When and How Should I Request a Good Cause Extension?
Learn About:  When and How Should I File a Grievance?
Return to: Medicare In-Depth

Clicking third-party links will open a new tab and will take you away from YourMedicare.com. YourMedicare.com, LLC does not control the linked sites’ content or link.

This content was created and copyrighted by the Medicare Rights Center ©2020. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from YourMedicare.com and may not be distributed, modified or edited without Medicare Rights’ consent.

YourMedicare.com takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a YourMedicare.com Licensed Sales Agent.