Resource
A Guide to the Medicaid Appeals Process
June 30, 2014
By the Kaiser Family Foundation
Medicare is usually appealed for two reasons:
- Ineligibility for coverage.
- Coverage denied for a specific service, or a service they were receiving was reduced, suspended, or terminated.
In order to successfully appeal an insurance decision, you need to know the correct way of approaching your insurance provider. There is a specific appeals process for each type of health insurance including private, public, federal, military, and Medicaid. This guide describes Medicaid’s appeals system, including the fair hearing process and the process required for Medicaid managed care organizations. As coverage expands under healthcare reform and efforts proceed to integrate services for dual eligibles, who are enrolled in both Medicare and Medicaid, protections through the appeals process will be increasingly important.