Filling an appeal when your Medicare advantage plan does not cover an item or a service

Medicare advantage programs cover many different services, prescription drugs, diabetic test supplies, and many different screenings. But what should you do if your plan will not cover the cost of an item or service you need?

Filing an appeal can help you dispute whether a service or item should be included in your plan. You may also file an appeal for items or services that should be continued, provided, or covered. 

Here are some tips to get the ball rolling with appeals:

• Get Help: If you are unsure how to move forward with the appeal process, simply appoint a representative. This representative can be a family member, attorney, doctor, friend, or advocate that acts on your behalf. Another option is to contact SHIP (State Health Insurance Assistance Program).

• Gather Information: Ask your healthcare provider or doctor for any information to help your case.

• Keep Copies: Make sure to keep a copy of all important documents that you send your plan as part of your appeal.

• Start the process: You have 60 days from the day of your coverage determination to file an appeal. Follow the directions of your plan’s denial notice and plan materials. If you file after the 60 days, You must provide a reason for filing late.

Once the appeals process is started, you can disagree with the decision made at any level of the process and go to the next level. 

Visit Benavest for more information on Medicare and Medicaid:

https://www.benavest.com/medicare-plans/

Reference: https://www.medicare.gov/