There are a few reasons your claim could be denied:

• the doctor you currently see or the hospital you went to is out of Medicare’s network
• the care you sought was not considered “necessary”
• you are still technically covered under another insurance plan
• the service you received is not a covered benefit (i.e. dental, vision, and hearing)

Update Your Medicare Information

First, if your Medicare claim is denied, make sure your current Medicare insurance information is up-to-date. Create an account on MyMedicare.gov. From there, input your Medicare plan information. Once your account is registered, you can see what plan you’re using, the benefits available to you, and any claims you have on file. This will also keep your claims from being rejected. Keep in mind, a rejected claim is different from a denied claim. To clarify, when a claim is rejected, there is missing or incorrect information that would be necessary for Medicare to complete the claim for you. Once you are certain that the information provided is accurate and valid, work on getting the denial appealed.

Filing an Appeal

Next, when you want to file an appeal, have as much information about your plan and coverage on hand as possible. The denial of the claim will have directions for the best way to go about getting the appeal process started. To start the process, contact your Medicare provider. You will need your Medicare Number from your Medicare card, a list of services you are requesting to have looked at, the dates in which those services were provided, and an explanation as to why you believe the denial should be refuted. The entire process is outlined step by step on the MyMedicare website.

Remember, make sure your Medicare plan is your primary insurance coverage before setting up any sort of doctors’ appointments. It is important to double check with your primary provider to see if they accept your Medicare plan. Do the same for any referrals you receive. Find out from your hospital if they accept your plan as well.