Medicare Appeal to Claim the Right

When you find the unfair treatment of Medicare, sending an appeal letter is the solution that you could do. Well, the Medicare appeal will be a formal document to tell the detailed condition and the right that substantively an individual should get.

Medicare itself is insurance provided by the US government for individuals who are aged 65 years or older. Of course, the members of this insurance should get the full facility when they need it. However, sometimes, missed communication becomes a problem between them.


What Does the Medicare Appeal Mean?

An appeal letter itself means a document that is written when an individual feels he or she has been treated unfairly, or they cannot get their right. This letter will be written as an effort to make someone consider a new decision given to them.

When it comes to Medicare, of course, the appeal letter will be addressed to the management of the insurance. The letter could consist of the facts and what the individuals need to get. Of course, all matters inside an appeal letter should be based on facts.

Reason to Write Medicare Appeal Letter

To make a clear explanation, these are some matters that could be the reasons why you need to write a Medicare appeal letter to claim your right. Some conditions that could be the reasons for writing this letter are:

  • A request for kinds of health service care, supply, item, and drug that Medicare should cover
  • A request for payment of a health care service from Medicare that you should get
  • A request to change the detailed amount that you need to pay for the health care service

What to Do in Sending Medicare Appeal Letter?

These are some matters to be done when you want to send a Medicare appeal letter, as:

  • Look at the detailed notice and circle items that become your question
  • Write down the detailed benefits or services that you are appealing to and complete it with their reasons
  • Use the redetermination request form that is provided by Medicare
  • Sign in and write down the contact number of you and Medicare
  • Send the copy to the address list of Medicare
  • Include any documentation to support your appealing

Sample of Medicare Appeal Letter

Dear Mr. Huston

Through this letter, I want to appeal the denial of my claim number 8181028 for the date of service of June 12, 2011. This was for the treatment that was performed on my wife at Jasmine Medical Center.

It is my understanding that the claim was denied and the hospital was not paid for the service. Furthermore, I also understand that the reason for denial because of the modifier code.

The next time, a supervisor of the hospital billing department has corrected the claim. It indicated that the treatment of my wife could be covered. That is why I send you this letter. Please consider my claim. Thank you for your attention.



That is all about the Medicare appeal letter that you need to know. Write it carefully and give the management a certain time to read and learn about your claims.



You may also like...