Medicare is a health insurance plan for people who are at or above the age of 65. This health insurance plan has been further categorized into A, B, C and D. These different categories cover various health facilities. There are times when Medicare denies the claims. This is not only a stressful situation, but very painful one as well. This denial prevents an individual from getting the due medical attention they need. This leads to a question that most people are asking, What If Medicare Denies My Claim.
Reasons For Denial
A doctor when mentions in his report that a treatment or therapy is not working for a patient, results in a claim’s denial. Another most common reason for claim’s denial is the therapy or care is to continue for a long time. Sometimes the home health care claim is denied because of the fact that the individual is not home bound. All these are reasons for denying claims.
What If Medicare Denies My Claim?
As stated above, Medicare gives reasons as to why they are denying a claim. The question arises as to what one needs to do in such a case. Every case has a different approach to reverse claim denial. With this approach, many individuals have been able to get the due medical attention they need, which is their right.
Examples of Claim Reversal
A patient suffering from a neurodegenerative disease got his claim denied for home health service because there were no chances of his improvement. The claim reversed because that patient talked to his doctor and got a letter stating that the home health service might not be something that would improve his health status but would indeed be beneficial to help slowing down the disease progression, as well as support him concerning the various medical issues that he is suffering from.
Note: After denial, an individual has 120 days to send the request form for reconsideration. One has a right to file four appeals once Medicare denies the claim.
We hope the above article answers your question, What If Medicare Denies My Claim.