| Dear Marci, I received a health care service that I believe should be covered by Medicare, but a few months ago, I got a notice saying that it would not be covered. Because I was very sick at the time, I missed the deadline for appealing that is listed on the notice. Is there any way I can still appeal the denial? -Evelyn (Durham, NC) Dear Evelyn, You may still be able to appeal Medicare’s decision to deny coverage for your care. An appeal is a formal request for review of a decision made by Original Medicare or your Medicare Advantage or Part D plan. When initially filing a Medicare appeal (and at each level of appeal), there is a limited time to file. However, after the deadline has passed, if you can show good cause for not filing on time, your late appeal may be considered. You can request a good cause extension at any level of appeal, and it is available for Original Medicare, Medicare Advantage, and Part D appeals. 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 you are appealing was mailed to the wrong address.A Medicare representative gave you incorrect information about the claim you are appealing.Illness—either yours or a close family member’s—prevented you from handling business matters.The person you are helping appeal a claim is illiterate, does 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 the reason has to do with illness or other medical condition, a letter or supporting documentation from your health care provider can be helpful. Some other general rules to follow when appealing the denial of a health service or item are:Try to understand the reason that your plan is denying coverage for your health service or item.Address any relevant coverage rules in your appeal letter, and encourage your doctor to do the same.If you need assistance understanding the coverage rules surrounding the service or item in question, you can contact your State Health Insurance Assistance Program (SHIP) for assistance by calling 877-839-2675 or visiting www.shiptacenter.orgKeep good records of all your communications throughout the appeals process. Some ways to do this are:Submit your requests in writing.Keep proof of when you send your appeal.Keep all fax transmission reports, mail information by certified mail, or return receipts.Write down details about phone calls regarding your appeal. This includes what you discussed, who you spoke to, and the date and time of the call.If you think you need help appealing, you can appoint a representative. The representative can be a friend, family member, doctor, or lawyer.-Marci |