By Jeff Rothstein I October 6, 2020

Medicare Advantage Plans (MAPD) are becoming increasingly popular with Medicare beneficiaries. If you currently have a Medicare Advantage Plan, you know it covers many products and services including:

  • prescription drugs
  • diabetic test supplies
  • cardiovascular screenings
  • hospital visits, and much more

But what do you do when your plan refuses to cover an item or service you need?

If you enrolled with a licensed and certified MAPD agent, call them and they will assist you. If not, you do have the right to ask your Medicare Advantage Plan to provide or pay for items or services you think should be covered, provided, or continued. To resolve these differences with your plan, you must know how to file an appeal.

Here are 4 tips to help you get started:

    1. Get help: If you want help filing an appeal, and you did not enroll with an agent; contact your State Health Insurance Assistance Program (SHIP) or appoint a representative. Your representative could be a family member, friend, advocate, attorney, doctor, or someone else who will act on your behalf.
    2. Gather information: Ask your doctor, other health care providers, or supplier for any information that may help your case.
    3. Keep copies: Be sure to keep a copy of everything you send to your plan as part of your appeal.
    4. Start the process: Follow the directions in your plan’s initial denial notice and plan materials. You have 60 days from the date of the coverage determination. If you miss the deadline, you must provide a reason for filing late. See what information to include in your written request.

Once you start the appeals process, you can disagree with the decision made at any level of the process and can generally go to next level. If you reside in South Florida, call Jeff Rothstein at South Florida Medicare. He can be reached at 954-270-9114. Jeff is a licensed and certified independent agent representing most MAPD and Medigap plans in Broward and Palm beach Counties and all his services are available at no cost to you as the insurance companies compensate him.