What You Should Do If Medicare Denies One Of Your Claims

Many people don't realize they can do anything about Medicare denial letters and assume they've made some mistake on their end during filing it. However, it's simpler than you might think to respond to a denial of benefits and there's a good chance you'll win the claim. You'll need to keep an eye on the paperwork you received regarding your Medicare plan and work quickly to stay within the deadlines set for making a challenge to their decisions.

Check Your Medicare Summary Notices

Medicare may send individual letters to let you know a specific claim was denied. It's easy to miss these notifications or not receive them at all. Checking your regular Medicare Summary Notices will help you stay on top of any claims denied over the last few weeks. This ensures you can make a rebuttal to the denial within the proper timeframe and don't miss it until it's too late to act. Open all your summary notices and check them over when they arrive to stay on top of any denials in need of response.

Correct Any Missing or Incorrect Facts

A large number of Medicare claims that are initially denied are simply filled out incorrectly in the first place. This is most likely due to coding errors made in the medical office, not any mistake on your part as a patient. You can call the helpline for your nearest Medicare office and request a Clerical Error Reopening of the case, which is different than repealing it. This allows you to communicate with your doctor and submit a new and improved claim that has the correct coding to ensure a higher chance of approval. If you already know what's wrong with the claim, try this method first.

Write an Appeal with Related Files Included

If you don't know why the claim was denied, you should gather evidence from your doctor that the treatment, medication, or device was truly medically necessary. Then write a basic letter of appeal and send it to the Medicare office that issued your summary letter, preferably with the notice of the denial included in the envelope. Make sure the letter has your full name and Medicare account details so the claim can be identified. Most claims must be sent in a couple of months of the denial, but this varies depending on the type of Medicare plan you have.

For more information, contact a company like American Eagle Health Insurance.