University Of Missouri Group Retiree

Ideally, Medicare will pay its share of your health costs without you having to do anything. But a new report by federal investigators finds that Advantage plans have a pattern of inappropriately denying patient claims. No matter how you choose to request a redetermination, you must send it to the company that handles your bills for Medicare. Your right to receive Medicare-covered services during and after your hospital stay, as ordered by your doctor.

If Medicare, your Medicare Advantage Plan (or other type of Medicare health plan), or your prescription drug plan denies you coverage for something you believe is necessary for your health, you can appeal the decision. IMPORTANT: For all appeals, ask your doctor to write a letter of support explaining why you need the service that was denied.

Participating providers should refer to their participating provider agreement and applicable provider manual for information on specific provider claim review or appeal rights. We'll get back to you within 7 days (72 hours if you request a faster decision).

All requests for payment appeals must include a completed How to Appeal Medicare Advantage Denial and signed Waiver of Liability (WOL) statement. For help, call the Medicare Rights Center national hotline (800-333-4114) or your state's Health Insurance Assistance program , a free resource for seniors who have questions about Medicare coverage.

HHS isn't the only organization questioning the increasing role of Medicare Advantage. If you disagree with the MAC's Level 4 Decision and the amount in controversy (AIC) is at least $1,350 (in 2012), you can file a civil action in your local federal district court.

If you are not happy with the decision made, you can request an appeal. If you are a Keystone 65 HMO member, you can file a standard or expedited medical appeal by using one of the methods below. OIG found that the range of claims appeals in MAOs was significant.