Patients with Medicare coverage have a guaranteed right to appeal decisions about their health care coverage. You can appeal a denial of coverage of a medical service or a refusal to reimburse your medical costs. Regardless of which type of Medicare you are appealing (Part A, B, C, or D), the appeal process starts out with a request for your Plan provider or Medicare administrator to reconsider the initial decision. Next you can ask a specific outside review body to review your claim. If you are still denied, you can request a hearing with an administrative law judge at the Office of Medicare Hearings and Appeals.
Medicaid appeals are much different, since Medicaid is a state-run program.
How to Appeal Your Original Medicare Part A or Part B Denial
If you are denied Medicare coverage or payment for a hospital stay or doctor's visit, here's how to appeal.
How to Appeal a Denial of Medicare Part C
If your Medicare Advantage Plan denies a request for coverage or reimbursement for health care services under Medicare Part C, you have the right to appeal if you disagree with the decision.
How to File a Fast Medicare Appeal of Your Hospital's Discharge Order
If you think your hospital discharge is too early, file a fast appeal with Medicare.
What to Expect at an ALJ Hearing at the Office of Medicare Hearings & Appeals
You must request an in-person hearing in writing and you must submit an explanation as to why the hearing needs to be in-person.
How to Appeal a Denial of Medicaid (Non-Eligibility)
If you applied for Medicaid and your state Medicaid agency denied your application, then you can appeal the denial.
Appealing a Medicaid Denial for a Service or Treatment
If you receive a notice of action that you are being denied Medicaid, appeal.
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Written by a former SSA medical consultant, Nolo's Guide to Social Security Disability discusses all medical conditions eligible for Social Security disability.
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