Medicare Advantage Appeals
Beneficiaries enrolled in a Medicare Advantage plan (or other Medicare health plans that are not fee-for-service) have the right
to appeal decisions related to their Medicare Advantage plan’s decision to end Medicare-covered skilled services in the nursing home setting or provided by a home health agency.
The official notice to end covered services is called a “Notice of Medicare Non-Coverage.” The plan must deliver the Notice of Medicare Non-Coverage no later than two days before coverage will end.
When you receive a Notice of Medicare Non-Coverage, if you disagree with the decision that services should end, you have the right to request an appeal from Masspro. You can ask a family member or friend to represent you during the appeal. You must call Masspro no later than noon the day before the “Effective Date” listed on the notice.
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Call Masspro’s helpline at 1-800-252-5533, or the national Medicare Helpline at 1-800-MEDICARE (800-633-4227).
Note: If you call Masspro’s helpline outside of normal business hours (Monday−Friday, 8:30 am−5:00 pm), make sure to listen carefully to the after-hours helpline message and follow the instructions to leave a message.
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A Masspro review case manager will contact you to discuss the case with you and ask you for your views.
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The review case manager and a physician will look over your medical record. Masspro can take up to one calendar day from the time of your call to complete the review.
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We will inform you, the Medicare Advantage plan and your provider of our decision, first by phone and then in a letter. We will also tell you about your other appeal rights.
If you miss the deadline to request an appeal from Masspro, you may still appeal the Notice of Medicare Non-Coverage through your Medicare Advantage plan.
Notice of Discharge and Medicare Appeal Rights (NODMAR)
Beneficiaries enrolled in a Medicare Advantage plan (or other Medicare health plans that are not fee-for-service) have the right
to appeal decisions related to their Medicare Advantage plan’s decision to end Medicare-covered services in the in-patient hospital setting.
The official notice to end covered services is called a “Notice of Discharge and Medicare Appeal Rights” or NODMAR. The plan must deliver the NODMAR no later than the day before coverage will end.
When you receive a NODMAR, if you disagree with the decision that hospital care should end, you have the right to request an appeal from Masspro. You can ask a family member or friend to represent you during the appeal. You must call Masspro no later than noon the day after you receive the notice.
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Call Masspro’s helpline at 1-800-252-5533, or the national Medicare Helpline at 1-800-MEDICARE (800-633-4227).
Note: If you call Masspro’s helpline outside of normal business hours (Monday−Friday, 8:30 am−5:00 pm), make sure to listen carefully to the after-hours helpline message and follow the instructions to leave a message.
-
A Masspro review case manager will contact you to discuss the case with you and ask you for your views.
-
The review case manager and a physician will look over your medical record. Masspro can take up to one working day from the time of your call to complete the review.
- We will inform you, the Medicare Advantage plan and the hospital of our decision, first by phone and then in a letter. We will also tell you about your other appeal rights.
If you miss the deadline to request an appeal from Masspro, you may still appeal the NODMAR through your Medicare Advantage plan.
The Center for Medicare Advocacy can give you advice and free legal help during the appeals process. For more information, call them at 1-800-323-3205.
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