What To Do When a Medicare HMO Won't Pay
APPEAL TO THE HMO
Demand the HMO explain in writing why it denied coverage and request an expedited appeal. Back your appeal up with a letter from your doctor.
GET AN OUTSIDE REVIEW
If your appeal is denied, you can take your case to a private company under contract to Medicare. You have the right to see the HMO file on your case. Review it carefully, and be sure to provide all correspondence and other documents.
TRY AN ADMINISTRATIVE LAW JUDGE
This is your next step in the appeal process. It can take a year or more before your case will be heard. Until you get a date, keep asking about your case's status.
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Updated June 11, 1998 by bwwebmaster
Copyright 1998, Bloomberg L.P.