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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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