Medical Appeals. If you disagree with a full or partial medical denial made by Medicare, you may dispute the decision through the Medicare appeals process. To start this process, follow the directions given in the letter you receive from Medicare about the denial. We do not process Medicare medical appeals. In the event we deny payment of an amount for which this plan is responsible for a medical reason, you may dispute the denial with us. A medical appeal under this plan is a request for us to reconsider a full or partial denial of payment for services because we determined: • the service was not medically necessary or appropriate; or • the service was experimental or investigational. You may request an expedited appeal when: • an urgent preauthorization request for healthcare services has been denied; • the circumstances are an emergency; or • you are in an inpatient setting. How to File a Medical Appeal
Appears in 6 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
