Original Medicare: Claims: Appeals

If your claim is denied after your first appeal, you have 180 days from the date your redetermeination request is denied to request the next appeal. This appeal is to a Qualified Independent Contractor (QIC). The request is for a "reconsideration determination."

The form to use for this appeal is Form CMS-20033 which is available at http://www.cms.hhs.gov/cmsforms/downloads/cms20033.pdf or by calling 800.633.4227.

Ask your doctor if there is additional evidence he or she could add to the first letter to provide additional reasons why your request should be granted. For example, the requested service is standard practice in the area in which you live, or at the country's best hospitals.

If the denial provides additional reasons beyond those stated in the original denial, ask your doctor to write another letter refuting the new points.

When you send in the form:

• Keep a copy of the completed form and attached evidence with your Medicare file.
• Send the papers in such a manner that you have proof of receipt.

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