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How to Appeal When you are Denied Medicare

If you disagree with a payment or coverage decision made by Medicare, you have the right to an appeal. About half of every appeals are successful.

If you are enrolled in Part D or Medicare Advantage you have 60 days from the denial notice to file an appeal. You will start the appeal by appealing to your plan instead of Medicare. You will need to follow your plan’s instructions on their explanation benefits.

Medicare’s Part D has a fast-track appeal of 72-hours if you have not received your prescriptions and the waiting could put your health in jeopardy.  Otherwise, your plan must send you a notice of their decision within 7 days.

For more information on appeals visit Medicare’s website and click on the Claims and Appeals tab at the top of the page or call Medicare at 800-633-4227.

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