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 January 16

by Karen Purze

I got a call from a friend this week asking what she needed to do in order to appeal a denied Medicare claim for her mom. Her mom was overwhelmed and asked my friend to “take care of it.” (Sound familiar?!) Knowing it might not be as simple as just calling Medicare, she asked me where to start. Here’s the answer…

Appeal a Denied Medicare Claim Step 1: Get Permission

First, you’ll need to fill out and have your mom (or whoever) sign a form authorizing you to represent her in the appeal. It’s called an “Appointment of Representative” form. (You can download directly from Centers for Medicare and Medicaid Services here.) Note: if you’re trying to appeal a denied claim on behalf of a deceased person, you’ll also have to provide “proof of authority” documentation stating that you are the executor of the estate. 

Appeal a Denied Medicare Claim Step 2: Understand the Appeals Process

There are a lot of sites which describe the appeals process and give supporting information. I’m going to refer you to Medicare.gov because it’s quite usable and useful. It is also “the Official U.S. Government Site for Medicare.” So there. The appeals process is described on this page.

The appeals process differs depending on what type of Medicare plan you have (I know, right? Never easy.) The good news is that it’s all pretty well explained on the site.

Appeal a Denied Medicare Claim Step 3: Get Additional Help If Needed

If you need additional help or want someone to help you help your mom, contact your local State Health Insurance Assistance Program (SHIP). They provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers.

Good luck. Let me know how it goes!

Karen Purze

P.S. If you have a question you’d like me to answer, give me a call, or send me a note. I love hearing from you!

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