Make an Appeal
An appeal is the action you can take if you disagree with a provider’s decision to discharge you from the hospital or discontinue services, or if you wish to dispute a coverage or payment decision made by Medicare, your Medicare health plan or your Medicare Prescription Drug Plan.
If you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan, you can fi a formal appeal through the Medicare website. You have the right to appeal if Medicare, your Medicare health plan, or your Medicare drug plan denies one of these:
- A request for a health care service, supply, item, or prescription drug that you think you should be able to get
- A request for payment of a health care service, supply, item, or prescription drug you already got
- A request to change the amount you must pay for a health care service, supply, item, or prescription drug
You can also appeal if Medicare or your plan stops providing or paying for all or part of a health care service, supply, item, or prescription drug you think you still need.
Start with taking a look at your Medicare Summary Notice (MSN). If an item or service is denied, call your doctor's or other healthcare provider's office to make sure they submitted the correct information. If not, the office may resubmit. If you disagree with any decision made, you can file an appeal. The last page of the MSN gives you step-by-step directions on when and how to file an appeal.
Additional information about filing an appeal and the necessary forms can be found at Medicare.gov.
- Give you the information you need to make an informed decision
- Explain your options
- Help you file an appeal
Your state’s BFCC-QIO will provide the necessary information to help you make a decision before the payment deadline for continued care.
The BFCC-QIO can also explain your options if you miss the deadline or decide to request a review later.
To contact your BFCC-QIO for help with filing an appeal, locate your BFCC-QIO by using our interactive map or the BFCC-QIO contact list below. Also, you may visit Medicare’s website to file an appeal directly.
BFCC-QIO Contact Information by Region or State
Northeast and Caribbean:
Connecticut, Massachusetts, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, Virgin Islands, Vermont
Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia
Alabama, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Montana, New Mexico, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, Wyoming
Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon, Washington