Cheryl Zangrilil

Medicare Appeals Rights

If you disagree with what Medicare is allowing to be covered or the amount of your last bill, you do have recourse. Learn about you rights to appeal Medicare.

Medicare is one of the biggest government bureaucracies on the planet. As with any large bureaucracy whether it has to do with your health or your taxes are often very slow to adopt new procedures and technologies that apply directly to your health and quality of life. Unfortunately this is just a reality of having to utilize your social security and Medicare benefits. Another fact about large government bureaucracies is that many people are very intimidated the channels they need to go through to get their benefits. The reality is that you don’t need to be. You have rights.

The moment your Medicare health coverage starts you will have certain guaranteed rights to protect your medical care and insure that you get the appropriate help you need. If for any reason your coverage is denied, you will be able to appeal that decision within the system. There are three main reasons that you can appeal a decision that was made by Medicare. You can appeal if you don’t agree with the amount paid, you believe you were denied a service that you should have received or you believe a service was stopped before it should have been.

Appeals rights are very important because it can take Medicare up to five years or more before it approves new medical technologies for coverage. If you are denied coverage for a new medical technology, you can use the appeal right that you have to questions that rule. This allows you to get the care you want right away and sort out the details over time. Just remember that you are not guaranteed to have an appeals decision go your way so be careful that you are fighting a fight worth fighting.

Each time you get a statement of what Medicare pays; you will get instructions about how to file an appeal. If you decide to appeal, be sure to work with your doctor or provider to get any information that may help your case.

In addition to the right to appeal, you also have the right to get emergency services, to get treatment by doctors and at hospitals, to participate in treatment decisions and to know all your treatment choices, and to maintain privacy of personal health information.

You may also have additional rights if you are in a hospital or a skilled nursing facility or if your home health care ends. If you have any questions about your rights and protections within the Medicare system, you can call Medicare directly or work with a skilled and experienced Medicare enrollment specialist who can advise you on how best to handle the appeals process.

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