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Original Medicare: Claims: Appeals

The First Appeal

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You have 120 days to reqwuest a "redetermination" of the decision denying your claim.

The letter denying your claim states the reason for the denial. It's up to you to prove that the denial is not correct.

Show your doctor the denial papers and ask that he or she write a letter which responds to each of the points raised in the denial and which states that the subject health care is necessary. Ask the doctor to include any and all evidence which backs up the doctor's statements.

The form to use to request the redetermination is the Medicare Redetermination Request Form (Form CMS-20027). It is available by calling 800.633.4227 or online at: offsite link. The denial form you received includes instructions about where and how to submit this form.

Attach a copy of the doctor's letter and any attachments with your appeals form. Keep a copy of the completed form and the doctor's letter and attachments, if any, with your Medicare file.

Send in the form in a timely manner in such a way that you can get a receipt showing the date that the form was received (for example, U.S. Post Office, Return Receipt Requested, or any of the overnight services).

Professional help is available if you need it to complete the form.

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