Many Americans depend upon programs like Medicare to ensure that they can afford to pay for care. With health costs rising, and the economy still not in full recovery just yet, not everybody can afford the costs of their healthcare. That’s why government programs like these exist. However, they are not infallible and there are all sorts of situations in which legitimate Medicare enrollment applications are denied out of error. This can be devastating, and can leave you confused as well as wondering where you need to go next to right this wrong.
But no worries, as there are plenty of things that you can do to appeal the decision, and demand an answer for why your application was not approved. But you will have to act quickly, as there are limitations on how long you’ll have to appeal a decision. That means figuring out what you have to do, so that you can reinvestigate the situation, and have it resolved quickly enough to ensure that your coverage is not denied in the end, which could prove to be devastating.
Here are a few things that you can do when you’re denied, to appeal your Medicare enrollment decision:
1) First off, make sure that you’re applying at the right time.
One of the top reasons for denial, is just that you’re not sending in your application at the right time. There are sign up periods for when you immediately become available for Medicare coverage, but if you miss this window, you have to wait for the national open enrollment period. That takes place during January 1st until March 31st. Any application that’s submitted after these dates will automatically be denied.
2) Review the denial.
This way you can discern the actual reason for which your Medicare enrollment form was returned to you, so that you can figure out what went wrong and what you can do to avoid this mistake in the future. In many cases it’s just because of something that’s incorrect on your application, whether it’s an oversight or a bit of accidentally incorrect information. This means you can quickly correct those points and resubmit, and ensure that you’re going to get coverage fast.
3) File a reconsideration request.
This is the formal paperwork to ensure that you’re able to have your application reconsidered despite the reason that you were denied. The denial notice will inform you of where you can apply for a reconsideration request, as well as where you can file and present new evidence of why your Medicare enrollment should have gone through. Just remember however, that you only have 60 days after the time you receive your denial to apply for a reconsideration. After that, you will be automatically considered to have waived your rights to challenge the ruling.
4) If you are still denied, try requesting an ALJ hearing.
An ALJ is an administrative law judge, and this is basically an opportunity to have a legal meeting where you can gain answers. This way, you’re able to get a hearing with an insurance representative, and a judge, so that you can once and for all discern just why your application is being denied. You can also present your evidence and reasoning for why your Medicare enrollment application should be accepted. But jus as with reconsideration requests, you only have 60 days from your second denial to request a hearing.
5) Finally you can apply for a hearing with the DAB
If you still are denied after the ALJ hearing, you have an opportunity to apply for a DAB or departmental appeals board hearing. This way, you can meet with the insurance companies official appeal team, and present your evidence to them for why you need to be accepted. This is really your last chance for Medicare enrollment, and you have 60 days to apply for a meeting from the time of receiving an unfavorable ALJ notice. When you have to take things this far however, chances are you will not be able to qualify, but if you feel that your Medicare coverage should be going through, there’s no reason you shouldn’t take things to this level.