I believe my Medicare was wrongly denied or stopped. How do I appeal?
The steps to take depend on what Medicare coverage you have, what decision you want to challenge, and what your situation is. Call 1-800-MEDICARE to learn what you can do in your situation.[1619] If you need help filing an appeal, contact the California Department of Aging's Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.[1620]
You can also appoint a representative to act on your behalf. This can be a family member, friend, advocate, attorney, doctor, or anyone else you choose. You can appoint a representative in 2 ways:[1621]
- Along with your appeal, submit a written request that includes:
- Your name, address, phone number, and Medicare number;
- Your representative’s name, address, phone number, professional status, and relationship to you;
- A statement that clearly (1) appoints your representative, (2) authorizes release of your personal and health information to your representative, and (3) explains why you’re being represented; and
- Your signature and the date you signed; your representative’s signature and the date they signed.[1623]
HELPFUL HINTIf you are eligible for both, Medicare and Medi-Cal (“Dual Eligibility”)
Those Eligible for Both Medicare and Medi-Cal: People who qualify for both Medicare and Medi-Cal are known as “dual eligibles” or “Medi-Medis.”[1624] People typically become “dual eligible” by first being enrolled in one program and later becoming eligible for the other program. For example, someone may already meet Medi-Cal’s income requirements, and then age into Medicare when he or she turns 65. Dual eligibles do not necessarily receive the same benefits from Medicare and Medi-Cal.[1625] The majority of dual eligibles receive full Medi-Cal benefits and assistance with Medicare premiums and cost-sharing.[1626] For counseling on dual eligibility, go to Health Consumer Alliance’s (HCA) website and view their list of local HCA call centers at http://healthconsumer.org/index.php?id=partners, or visit Cal MediConnect’s website at www.calduals.org.
- 1619
How Do I File An Appeal?, Medicare.gov, http://www.medicare.gov/claims-and-appeals/file-an-appeal/appeals.html ↑
- 1620
- 1621
http://www.medicare.gov/claims-and-appeals/file-an-appeal/appointing-a-representative/get-help-filing-an-appeal.html ↑
- 1622
Available online: http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms1696.pdf ↑
- 1623
Can Someone File an Appeal for Me? Medicare.gov, http://www.medicare.gov/claims-and-appeals/file-an-appeal/appointing-a-representative/get-help-filing-an-appeal.html ↑
- 1624
Check Medi-Cal Eligibility, CalQuality.org, http://www.calqualitycare.org/learn/nursing-homes/pay/medical ↑
- 1625
Dual Eligibles Fast Facts, CalDuals, http://www.calduals.org/background/fast_facts/ ↑
- 1626
Fore more information about dual eligibility, please visit: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/4091-08.pdf ↑