What to do When Your Medicaid Claim Has Been Denied
Medicaid can help individuals with limited resources to cover medical expenses. Despite its assistance in alleviating some of the stress that often accompanies medical costs, sometimes Medicaid can cause more stress…like when your claim is denied.
There are certain reasons as to why your claim has been denied, and what you can do next to combat it. If your state Medicaid agency has denied your application, then you have the right to appeal it. Your appeal must follow federal Medicaid appeal rules.
You may be denied Medicaid because you have too much income and/or assets; or if you applied based upon a disability, but your Medicaid agency does not believe that you are, in fact, disabled.
The Written Notice
When Medicaid denies a claim, it is obligated to issue a written notice of denial. Adhering to federal deadlines, states must send you a written denial notice either:
- 90 days from the date of your application, if your application was on the basis of a disability
- 45 days from the date of your application, if your application was on the basis of anything else
The notice should tell you that you have the right to appeal the decision and how you can do so, as well as the reason for denial and the rules that your state Medicaid agency is using as a basis for denial.
One of the most important things on the notice is the deadline for appeal. Though all states have a deadline of no later than 90 days from the date of the denial, different states have different deadlines within that range. You must request an appeal within that time period, or you will be obligated to justify a late appeal.
The notice will also state how to appeal. Regardless of whether or not your state requires your notice of appeal in writing, it is good habit to practice, so that there is no confusion later on that you were in compliance.
In New York, for example, you have 60 days from receipt of a notice of denial to file for a fair hearing.
Once your appeal hearing is scheduled, you must appear either in person or on the phone, dependent upon state procedures. If you do not appear you risk losing your opportunity to appeal.
Prior to the hearing, federal Medicaid rules demand that states allow Medicaid applicants to view and review their files and their documents. Though you can represent yourself, it may be in your best interest to find an attorney to represent you.
Alternatively, you are allowed to use a relative, friend, or other spokesperson of your choice to help you with your appeal.
Once you have completed your hearing, you will receive another written notice of the decision. It is important to read the notice in full to determine how your state permits you to proceed if there is a need for another appeal.
Should you prove your case and win your hearing to qualify for Medicaid, the state agency must apply your coverage retroactively to the date that you first became eligible. In most states this is the day that you filed the Medicaid application.
Because of this, it is important to keep track of any expenses that you incur from that date of application onward.
Brooklyn Elder Law Attorneys at Korsinsky & Klein, LLP Assist with Medicaid Claims
If you or a loved one has been the recipient of a Medicaid claim denial, we can help. The Brooklyn elder law attorneys at Korsinsky & Klein, LLP work with individuals from our offices in Brooklyn, New York, and Lakewood to assist with their Medicaid needs. To learn more about your Medicaid claim denial and what to do next, contact us online of call 212-495-8133 today. We serve clients across Manhattan, Long Island, and Westchester, New York.