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. 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.
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:
- 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.
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.” 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. The majority of dual eligibles receive full Medi-Cal benefits and assistance with Medicare premiums and cost-sharing. 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.
How Do I File An Appeal?, Medicare.gov, http://www.medicare.gov/claims-and-appeals/file-an-appeal/appeals.html ↑
Available online: http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms1696.pdf ↑
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 ↑
Check Medi-Cal Eligibility, CalQuality.org, http://www.calqualitycare.org/learn/nursing-homes/pay/medical ↑
Fore more information about dual eligibility, please visit: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/4091-08.pdf ↑