Skip to main content

File a Medicare appeal

What’s an appeal?


Let’s say you asked us to pay for a medical or dental visit. Or maybe it’s a prescription medication. But the request was denied. You can ask us to look at it again. This is called filing an appeal. You have to file an appeal within 65 days of the denial. Your doctor, a family member or someone you trust can also do this for you.

  • Did you get a Notice of Medicare Non-Coverage (NOMNC) that your stay or services are going to end? It might look different depending on the kind of care you’re getting:

     

    • Home health care: You’re getting medical care in your own home. 
    • Skilled nursing care: You’re a patient in a skilled nursing facility.
    • Rehabilitation care: You’re getting outpatient care at a Medicare-approved Comprehensive Outpatient Rehabilitation Facility (CORF).

    Your notice lists a group called the Quality Improvement Organization (QIO). Call them if you don’t agree with being sent home or ending care. Tell them what care is ending and say you want a “fast-track appeal” — that means they’ll help you quickly.

     

    If you can't find their number, call the Member Services phone number on your Allina Health | Aetna Medicare member ID card. We can help you get in touch with them.
     

    Level 1 appeal (QIO review) 

     

    How it works: 

     

    • Call the QIO (by noon the next day) after you get the notice.
    • They’ll look at your appeal and contact you within two days with their decision. 
    • If they say no, you can file a level 2 appeal.

     

    Level 2 appeal (also called a reconsideration)

     

    How it works:

     

    • If the QIO said no to your Level 1 appeal, contact them within 60 days. 
    • They’ll get back to you with an answer within 14 days.

     

    In-patient hospital discharge

     

    While you’re in the hospital, you’ll get a notice called “An Important Message from Medicare About Your Rights.” You have the right to:

     

    • Ask to stay if you think you’re being sent home too soon.
    • Get the medical care you need, and know/ask who will pay for it.  
    • Help make decisions and speak up if you're not happy with your care.  

     

    If you think you’re being sent home from the hospital too soon, call the QIO for help.

     

    Learn more about Quality Improvement Organizations

What type of appeal do you want to file?