How to file Medicare appeals, deal with issues, claims, problems, etc.
How to file a complaint – Medicare.Gov
Medicare Appeals Publication # 11525 60 pages
HICAP CA * Rest of USA * (Health Insurance Counseling and Advocacy Program) provides free, confidential one-on-one counseling, education, and assistance to individuals and their families on Medicare, Long-Term Care insurance, other health insurance related issues, and planning ahead for Long-Term Care needs. HICAP also provides legal assistance or legal referrals in dealing with Medicare or Long-Term Care insurance related issues.
HICAP counselors are trained in Medi-Cal and Medicare and can help you understand the complex insurance options to find the best fit for you. You can also learn about Medicare or Medi-Cal by attending community presentations or conferences conducted by HICAP counselors. Medicare & You – see link in side panel
***Sure they might be of help, but how much training, licensing, malpractice coverage and experience do licensed agents have. Look at all the information on this site!
- This is NOT sales literature, but is provided as a public service for educational purposes.
- AARP Procedures on problems, complaints & appeals from EOC
See our main webpage on Appeals & Grievances
Sibling & Child Pages
Our general section on Appeals & Grievances
- Appeals & Grievances Medicare
- Covered CA Appeals
- Grace Periods? NEVER get cancelled Non-Pay!!!
- Automatic Premium Payments – Benefits and Advantages
- Grace Periods – How long? Premiums Due? Subsidy Pay Back?
- Pay ALL premiums – even if you lose subsidy
- Paying Back Premiums to get reinstated?
- Was the cancellation legal? Web Visitor Q & A
- Insurance Application Disclosures – Table of Contents only
- Last Minute Application? When does coverage start?
- Medical Necessity – reasonable and necessary
- Plain Meaning Rule – Read the statute 3 times
- EOC Evidence of Coverage Value and how to find
- Maxims of Law – Proverbs
- Unlawful Practise of Law
- Law – Other than Insurance
- CA Vehicle Code – no index
- Civil Law – no index
- Criminal Law
- ADW count as a strike?
- Competence to Stand Trial
- Factual Finding of Innocense
- Judy Meyer for Judge
- Perjury – What is the definition?
- Restraining Order – Protective Persons Violation – Aid & Abetting
- Types of Probation and Violation
- What is hearsay? Someone else said on the phone?
- Law – Other than Insurance
Technical & Research Links
One hour webinar by an attorney, on how to do claims & appeals – You Tube
42 CFR Part 422, Subpart M – Grievances, Organization Determinations and Appeals
- § 422.560 — Basis and scope.
- § 422.561 — Definitions.
- § 422.562 — General provisions.
- § 422.564 — Grievance procedures.
- § 422.566 — Organization determinations.
- § 422.568 — Standard timeframes and notice requirements for organization determinations.
- § 422.570 — Expediting certain organization determinations.
- § 422.572 — Timeframes and notice requirements for expedited organization determinations.
- § 422.574 — Parties to the organization determination.
- § 422.576 — Effect of an organization determination.
- § 422.578 — Right to a reconsideration.
- § 422.580 — Reconsideration defined.
- § 422.582 — Request for a standard reconsideration.
- § 422.584 — Expediting certain reconsiderations.
- § 422.586 — Opportunity to submit evidence.
- § 422.590 — Timeframes and responsibility for reconsiderations.
- § 422.592 — Reconsideration by an independent entity.
- § 422.594 — Notice of reconsidered determination by the independent entity.
- § 422.596 — Effect of a reconsidered determination.
- § 422.600 — Right to a hearing.
- § 422.602 — Request for an ALJ hearing.
- § 422.608 — Medicare Appeals Council (MAC) review.
- § 422.612 — Judicial review.
- § 422.616 — Reopening and revising determinations and decisions.
- § 422.618 — How an MA organization must effectuate standard reconsidered determinations or decisions.
- § 422.619 — How an MA organization must effectuate expedited reconsidered determinations.
- § 422.620 — Notifying enrollees of hospital discharge appeal rights.
- § 422.622 — Requesting immediate QIO review of the decision to discharge from the inpatient hospital.
- § 422.624 — Notifying enrollees of termination of provider services.
- § 422.626 — Fast-track appeals of service terminations to independent review entities (IREs).