How To Appeal a Medicaid Decision

Your Medicaid claim can be denied for different reasons. There might be services not covered by your health care plan or provider or your provider submits a claim that’s much higher than the payment of Medicaid for the service. Read the following steps on how to appeal a Medicaid decision.

  • Call your case manager. There is a case manager for every Medicaid beneficiary. Contact your case manager to aid you navigating the Medicaid process. Let your case manager understand that you desire to appeal for a decision so he can help you finish the process.
  • Send a letter of appeal to Medicaid appeal representatives near your area. The letter must be addressed to Bureau of Appeals. Some states will give you a choice to call and state your appeal personally in their office.
  • Fill out your appeals form. It’s easy to ask for a copy of Medicaid decisions’ appeal form. You just need to give them your Medicaid information with your reasons why you’re appealing the claim.
  • Get your physician’s statement. It is important and it is mostly required during appeals process. Your physician’s statement will affirm that you need available services.
  • Wait for Medicaid’s decision. They will review your case. The appeals department will tell you if you have succeeded in your appeal. The review of your appeal can last up to three months.

Note that there’s a deadline on your claim that’s given to you by Medicaid. You must appeal your decision on time so it would be considered. Surf the Medicaid website on your state for additional information that will help you on your appeals process.

Medicaid Application

You just need to communicate to your local social services department and show evidences that you need financial aid so you can apply for Medicaid. Below are instructions on how to apply for Medicaid.

  • Understand that there are various eligibility requirements and application procedures for every state. Also, understand that Medicaid is a program by the state to help poor people. Only people who need financial assistance are eligible.
  • The Social Security Administration must give you SSI (Supplementary Security Income). You need it for you to become qualified for Medicaid.
  • Medicaid has limitations. Understand the limitations so you can identify your benefits.
  • Contact your state’s Department of Human Services or Social Services. Ask those departments for Medicaid might be under a different name in your state.
  • Have a Medicaid application. You need to fill-up the form in Medicaid’s office.
  • Compile needed papers. For your application, you need to bring your birth certificate, pay stubs, driver’s license, proof of address, Social Security card, and bank account numbers that you have.
  • Prepare in answering possible inquires regarding your finances. Your eligibility will be based on your income.
  • You have the right to inquire. Ask an office personnel if you have questions so you can fill-up the form properly.
  • Ask for Help. Ask for your family member’s assistance if you want to apply but can’t leave home.

Ensure that all your facts are true because you might lose your appeal or application and if you cheated.


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