When a Medicare recipient is denied coverage of a service, she can appeal the decision. However, if she is dealing with health problems, it may be difficult to do.
A Medicare recipient can appoint a representative to assist with the appeals process. She can appointment a family member, a friend, a physician, her attorney, or another person to help. The person can then file any necessary paperwork and obtain medical information.
There are two ways to appoint a representative:
- The recipient can complete the Appointment of Representative form, which can be found the on the Medicare website.
- The recipient can submit a written request with the appeal. The request must include information about the representative, including contact information; a statement of appointment; a description of the representative’s professional status, such as a doctor; and, an explanation of why the Medicare recipient is being represented. The request must also contain a statement authorizing release of medical information to the representative. The request must be signed by both the Medicare recipient and her representative.
A Medicare recipient can also get help with appeals from the State Health Insurance Assistance Program (SHIP). Florida’s SHIP program is called Serving Health Insurance Needs of Elders (SHINE). Trained volunteers help with health insurance questions, including Medicare and Medicaid. To contact SHINE, call 1-800-963-5337.
For more information about appealing a Medicare denial, contact 1-800-MEDICARE or visit the Medicare website.
