Did Medicare deny you coverage on a service or medication you need? What happens if for one reason or another, you miss the deadline they give to appeal their decision? Is there anything you can do? The good news is, you may still be able to appeal Medicare’s decision to deny coverage for your care. For all levels of appeals through Medicare, there is a limited time to file. However, if the deadline has passed and you can show good cause for not filing on time, your late appeal may still be considered.
It’s called “a good cause extension” Extension requests are considered on a case-by-case basis, so there is no complete list of acceptable reasons for filing a late appeal, but some examples include:
The notice was mailed to the wrong address.
A Medicare representative gave you incorrect information.
Illness; either yours or a close family member’s
You are illiterate, do not speak English, or could not otherwise read or understand the coverage notice.
If you think you have a good reason for not appealing on time, follow the instructions on the notice for appealing, and include a clear explanation of why your appeal is late. If available, supporting documentation is helpful. While each situation is unique, it is important to stay on track and be as clear as possible for why you want an appeal. It’s helpful to know your policy and also understand why the plan is denying coverage. You can use that information to point out specific and relevant coverage rules that prove this service should be covered,
It is also highly recommended that during the appeal process that you take detailed notes on communications you have had. If calling into the Plan, always write down details about the call, the name of the Rep you spoke with along with the date and time. Anything you request over the phone, should also be requested in writing. Keep any fax logs and mail information (always use signature confirmation or delivery confirmation when sending highly sensitive information with specific deadlines to any Government agency.
Lastly, if you feel that you can not get a grasp on the the appeal process or need help, you can appoint a representative to assist. A Representative can be a Lawyer, Family Member, or Friend. Or if you enrolled through a Brokerage like us here at, Total Benefit Solutions, Inc. a friendly Account Rep would be happy to assist you in the process. Not only do Brokers provide you with help with issues such as appeals, but they also go over all available plan options so that you get the best policy suited for your needs. If you didn’t sign up last enrollment period, consider giving us a call at 215-355-2121 to discuss your needs. You can also shoot us an e-mail to be added to our call list, which gives you a friendly reminder closer to open enrollment.
As always, if you have any questions or concerns about your coverage, please feel free to give our office a call at 215-355-212.