Medicare HMOs are required to allow you to appeal, if you believe you were wrongly denied services or coverage for your health care.

For example, you may appeal an HMO decision not to provide you with services that you believe the HMO should be providing. You may also appeal an HMO decision not to pay for your emergency or urgent care. The HMO member relations office will provide you with specific instructions for filing an appeal.

HMOs are required to provide you with a written statement alerting you to your appeal rights when they deny you the services you believe you need. Regardless of whether you receive this statement, you can write to the HMO requesting that it reconsider its denial. The HMO undertakes an internal review which should take no more than 72 hours, when urgent care is needed, and in other cases, no more than 30 days.

If the HMO still denies you services, it should automatically forward your appeal to the Center for Health Dispute and Resolution (CHDR). CHDR works under contract with Medicare to review HMO denials.

If you are still dissatisfied after receiving CHDR's decision, you can request a hearing before an Administrative Law Judge (ALJ). The CHDR denial letter will explain the procedure for requesting an ALJ hearing.

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