AARP Hearing Center
Filing medical claims is dull work that usually pays off. But, sometimes, it’s just dull. When Medicare, Medicaid or insurance kicks back a claim or request, it can add angst to the already stressful job of caregiver.
“Denied” sounds final and sometimes it is, but it may be just a way station on the road to approval.
Insurance plans, Medicare and Medicaid all have appeals processes and people to walk you through them — but you have to follow their rules. The first is: Don’t procrastinate. Some plans and providers turn unpaid bills over to collection agencies after 60 days. File Medicaid appeals ASAP. The most generous deadline is 90 days from the date the denial was mailed, but state deadlines vary. Check the rules for the patient’s state when the denial arrives. If you miss the deadline, you will have to justify a late appeal. The Medicare cutoff varies depending on if it’s Medicare A, B, C or D.
Steps to Take Before Starting an Appeal
If the service has been completed and the payment denied by Medicare, Medicaid or an insurance plan, do this before starting an appeal:
- Ask the hospital or doctor’s business office for copies of the medical records.
- Compare records with bills. The wrong code or date, a misspelled name, a digit off an account number or incomplete paperwork can be cause for denial.
- If you find a discrepancy, report it to the billing office and ask that it be corrected and the claim resubmitted.
- Ask for an explanation of any questionable charges.
- If the answer is not satisfying, ask to speak with a manager.
If the problem is not in the paperwork, or if your loved one has been denied a medical service or treatment you believe is essential to his or her health, it’s time to appeal. Here's how.
Medicare
Medicare recipients have the right to appeal denial of the following:
- health care services, supplies, equipment or a prescription medication
- supplies, health care services or prescriptions already received
- skilled nursing, home health care or treatment at a comprehensive rehabilitation facility
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