![]() ![]() Your Level 1 appeal ("reconsideration") will automatically be forwarded to Level 2 of the appeals process in the following instances: If you are receiving services in an inpatient hospital, skilled nursing facility, home health agency or comprehensive rehabilitation facility, you may request an immediate review by a Quality Improvement Organization, if you disagree with your Medicare Advantage plan's decision to discharge you or discontinue services. You or your physician may request an expedited reconsideration by your Medicare Advantage plan in situations where the standard reconsideration time frame might jeopardize your health, life, or ability to regain maximum function. Special Circumstances for Expedited Review 60 days if the decision involves a request for payment.30 days if the decision involves a request for a service.In most cases, your plan will notify you of its reconsideration decision within: When You Will Get a Response (i.e., "reconsideration decision") ![]() You may request reconsideration by your Medicare Advantage plan within 60 days of being notified by your Medicare Advantage plan of its initial decision to not pay for, not allow, or stop a service ("organization determination").At Level 1, your appeal is called a request for reconsideration.Your Medicare Advantage plan must inform you in writing on how to request an appeal.How to Request an Appeal (i.e., "request for reconsideration") You may contact your plan or consult your plan materials for detailed information about requesting an appeal and your appeal rights. If you are in a Medicare Advantage plan, you can appeal the plan's decision to not pay for, not allow, or stop a service that you think should be covered or provided. ![]()
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