Medicare Problems and Appeals
- Medicare coverage decisions often lead to confusion or disagreement, but most situations
can be resolved--or at least clarified--with a little persistence.
- You have the right to appeal any Medicare decision. Most appeals are successful.
- By taking the time to understand your loved one’s coverage in the first place, you’ll
be less likely to receive a surprising decision.
Next Step
Contact your State Health Insurance Assistance Program (SHIP) office for help with
Medicare appeals, disputes, or other problems.
Medicare’s many rules and regulations can be overwhelming. It’s easy to get frustrated
when you receive confusing or seemingly inaccurate information. Don’t assume the
worst when you get discouraging news--it might be the result of a simple error.
You can greatly increase your chances of resolving a Medicare problem by knowing
your rights, being persistent, and following a few simple tips:
- Read everything carefully. Look over any statements or documents your loved one
gets from Medicare or a private Medicare plan. Call for clarification if needed.
- Meet deadlines. If you get a denial of coverage and want to appeal it, make sure
you do so within the allowed time period. Follow the directions that came with the
denial.
- Call if you need more information. You have the right to receive all the information
you need, whether it is from your plan, provider, or Medicare.
- Take notes. During every phone call, ask for the name of the person you’re speaking
with and take notes about the conversation. If someone is unable or unwilling to
help you, ask to speak to his or her supervisor.
You have the right to appeal any healthcare decision made by Medicare, your doctor,
your hospital, or a privately offered Medicare health plan. It pays to be patient:
Over 70 percent of Medicare appeals are ultimately decided in favor of the person
appealing.
Lost Medicare Card?
If a Medicare card is lost or damaged, you can order a new one by visiting Social
Security Online or calling the Social Security Administration
at 1-800-772-1213.
Next Step: Contact your State Health Insurance Assistance Program (SHIP) office for help with Medicare appeals, disputes, or other problems.
