Video instructions and help with filling out and completing Fill Form 5495 Appeals

Instructions and Help about Fill Form 5495 Appeals

How to file an appeal with Medicare know your rights hi I'm Lynne safety I'm a licensed insurance broker I specialize in Medicare supplement plans and retirement planning my email is l ZAF key at retirement planning systems net if you have any questions concerning the appeal process please contact me how do you file an appeal most of us when you get a decision from Medicare about whether a claim is going to be paid or not simply pay it if the claim was denied we never question whether it can be appealed or not and an appeal is not difficult and it costs very little bit of time it but it depends on what type of Medicare insurance coverage you have as to where you file your appeal if you have Original Medicare and a supplement plan you would file an appeal with the Center for Medicare and Medicaid Services they have a form online that you can download to your computer I will attach a link to the description of this video below if you have a Medicare Advantage plan you would have to file an appeal with the Advantage plan insurance carrier how you file an appeal for a Medicare Advantage plan should be found within your plan summary of benefits or the details about your Medicare Advantage plan or you can contact your insurance agent if you have one for most of this presentation we'll be talking about filling filing an appeal with the Center for Medicaid and Medicaid Services the primary reason is if Medicare denies your claim the insurance company cannot pay their portion of that claim if Medicare didn't pays that claim the insurance company must pay the remaining part of the bill they have no choice this is why if a claim is denied with the insurance Medicare with a Medicare supplement plan the appeal has to be through the Medicare portion or the government portion of Medicare when Medicare denies or pays a claim they send a Medicare summary of notice that shows the item or service that they paid or denied this is an explanation for this is found on page 65 of the Medicare and you handbook you will have 120 days from the Medicare summary notice or MSN to appeal this denial medicare has several reasons for not approving charges some of the reasons they may not approve is that they need a doctor's order stating that a service or item is needed for a person's health such as a person who is a diabetic may need certain types of foot care regular foot care is not covered under Medicare except for diabetics but they the diabetic needs a doctor's order when you get your MSN from Medicare simply Circle the item that you disagree with and write an explanation as to why you disagree with the decision on the MSN or a separate piece of paper or and attach it to the MSN I there's also a form in the description below this video include your name phone number and Medicare number on the MSN sign it with your explanation and make a copy to keep for your records I want to stress you need to make a copy of everything then you send it to Medicare at the address should be in the MSM for them to reconsider there didn't it may be helpful to get a letter from your provider about the service or item in question sometimes a service or item is simply coded wrong in the billing process this can be correct rather easily as I stated before you must file the appeal within 120 days of receiving the msn in the mail after this there is no option for appeal of a charge Medicare Advantage plans after generally you'll get a decision from Medicare within sixty days after filing your request they will send you another msn their decision if you have a Medicare Advantage plan the appeals are filed through the insurance company if you have been denied a payment for an item or service and you think that you should have been paid don't be afraid to file an appeal an appeal does not take much time and it doesn't cost you anything often appealed services or decisions about services are overturned you can find out how to file an appeal with the Medicare Advantage plan by looking at the materials sent to you by the insurance company in some cases you can expedite the appeals process if needed there is no cost to filing an appeal prescription drug plans also have an option to file an appeal if a drug is not on the formulary of your prescription drug plan you can simply file an appeal include a letter from your doctor stating why the drug is necessary your prescription drug plan will often allow an exemption this is often the case for people unable to take the generic form of some medications I'm Lindsay I hope you found this of value I'm a licensed insurance broker I specialize in Medicare supplement plans and retirement planning you can contact me if you have any questions at ELLs F key at retirement planning systems net I want to thank you for listening to my presentation