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
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