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Appeals and Exceptions: Requesting Coverage Step by Step

Step 3: Request a reconsideration.

If your request for coverage is not granted after a redetermination, request a reconsideration. In this step, an independent entity will review the case and make its own decision.

How to Request: You or your appointed representative must make this request in writing to the "Independent Review Entity" (IRE). The letter you received in response to your redetermination request will give you the address and instructions on how to write to the IRE.

Timeframe: You must make this request within 60 days of receiving a denial of your request for coverage under the redetermination.

Decision: A decision must be made by the IRE and sent to you as soon as your clinical condition requires, but no later than 7 days (72 hours for an expedited request). If your request for coverage is denied under the reconsideration and you wish to appeal further, you may want help from a lawyer. (If you need help finding a lawyer, contact the Eldercare Locator by calling 1-800-677-1116 or visiting www.eldercare.gov.) You will get information about how to appeal further when you are told that your request for coverage has been denied under the reconsideration.

For more information about additional steps in the Medicare appeal process, see www.MedicareDrugAppeals.org.