If I ask for a reconsideration, how soon will I get a decision on my case?

September 20, 2009 by admin

Yes. If you are in the Original Medicare Plan, there is a 5 level appeals process that you can use to request coverage for an item/service that you think is medically necessary. You can ask for a redetermination (first appeal level) from the contractor that handles Medicare claims and a reconsideration (second appeal level) from a Qualified Independent Contractor (QIC). If you disagree with the QIC's decision you can appeal to an Administrative Law Judge (ALJ). If you disagree with the ALJ's decision you can appeal to the Medicare Appeals Council (MAC). If you disagree with the MAC's decision you can file an appeal in U.S. district court. It is important to remember that the decision letter you receive at each level of appeal will explain additional appeal rights you may have, so you should read these decision letters carefully.Discharge Appeal RightsIf you are getting Medicare services from an inpatient hospital, skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice, you may have the right to a fast appeal if you think your Medicare-covered services are ending too soon. You will get a notice from your hospital/facility that explains how to ask for a fast appeal. If you do not get this notice, ask for it.