Medicare Advantage: Claims: Appeals
Rules The Plan Must Follow When Making A Denial
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The denial of a service (or discontinuance of an ongoing treatment) must:
- Be in writing.
- State the reasons for the denial clearly and in terms that will allow you to argue your case.
- List all appeal rights you have, including time limits.
- Provide instructions on how to obtain evidence, including medical records and supporting affidavits from attending physicians.
- Give you a timely response based on the seriousness of your medical condition.
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