Medicare is one of the health insurance programs that’s used in the United States since 1966. It covers the cost of different types of accidents that might happen to you so you won’t have any problems regarding the steep prices of hospital bills.
There are times when Medicare gets mistakes regarding the costs that it manages to cover on your medical expenses. If this happens to you, then you have to file an appeal in order to get the proper coverage of the costs of your Medicare health plan.
Now, what are the 5 levels of medicare? Here we’ll explain all of that to let you know how to process an appeal.
The first level of Medicare appeal is Redetermination. This is where you will try to have a re-examination of the initial claim that you have filed which is read by the Medicare Administrative Contractor who is not connected to the initial claim determination that you have made.
This level is basically a reconsideration of the first decision that was made as you deem it unsatisfactory to your Medicare needs.
If your filing of the claim that you made was still denied by the contractor then you can proceed to the second level in which reconsideration is done by a party that’s not affiliated with medicare.
They will try to reevaluate the outcome of your claim through a fresh new perspective while considering every medicare regulations and all the information that you’re able to provide for them.
The process will also depend on the nature of your case so you need to keep that in mind.
Administrative Law Judge
If the independent panel on level 2 has still denied your claim, then you should then go to level 3 which is an administrative law judge to request a form 30 days after you’ve received your denial.
You will then follow up with supporting documents and statements for your reconsideration. A hearing will then be done which will have you to participate and also a representative from Medicare. The decision for your claim to be approved or rejected will be finalized within 90 days.
Review by Medicare Appeals Council
If you still want to pursue your case if it’s rejected by the medicare appeals council then you have to take it to level 4 where it’s reviewed by the medicare appeals council.
They will review your case without the need for any court hearing and they will only check if the evidence is deemed fair and if it abides by their policies.
Hearing in Federal Court
The final level of appealing your medicare claim will be in court. This will require you an attorney and it will be seen through by a federal judge. The judge will then review your case with the disputed amount given into account.
Going through each level of Medicare will be quite strenuous for you so make sure you have the required amount of evidence and proper understanding of their system before you file a complaint.