Senior News: Appealing a Denied Medicare Claim

Every quarter you’ll receive a Medicare statement. It’s important that you inspect this form — going over every item — and look for mistakes.

Kaiser Health News has issued a report showing how to handle any mistakes you find:
If a claim is denied, you’ll want to take steps to appeal. Hold on to your quarterly statement and circle the items in question.

If you have a computer, go to the Medicare site (www.medicare.gov) and click on Claims & Appeals. You’ll get a list of instructions. Down the page at Get Medicare Forms, you’ll find the forms you need for either a claim or an appeal. You also can file a claim online at the above link.

If your claim is denied, be sure to appeal within 120 days. If you’re denied again, file again, asking for a second appeal. If denied, for your next appeal include a letter describing what the payment was for. Include a copy of the previous denials of your claim.
Your next appeal will be to ask for a hearing before an administrative law judge. This likely will be a conference call between you, your doctor and the judge.

Only 2 percent of errors are ever challenged when it comes to denied claims. Those who are denied a claim often give up. It takes energy and perseverance to have the corrections made, but it’s to your benefit, even if it takes a second or third try. It’s on the third try that you’ll have the most success, so don’t give up if you know you’re right.

For free help in filing appeals, contact your State Health Insurance Assistance Program (SHIPS) office. Find them by calling your local county office on aging.

Matilda Charles regrets that she cannot personally answer reader questions, but will incorporate them into her column whenever possible. Write to her in care of King Features Weekly Service, P.O. Box 536475, Orlando, FL 32853-6475, or send e-mail to columnreply@gmail.com.

(c) 2013 King Features Synd., Inc.

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