Medicare Appeals Procedures
If you are not sure which procedures apply, please follow these instructions to appeal. We will apply the right procedures to your case.
If you do not agree with the Administrative Law Judge’s (ALJ’s) decision or dismissal order, you may appeal to the Medicare Appeals Council (the Council). Other parties may also appeal. We call an appeal to the Council a “request for review.” The Medicare agency may also ask the Council to review the ALJ’s decision or dismissal order on its own motion.
You may appoint an attorney or other person to represent you. Some legal aid groups may provide legal services at no charge.
What to Include in Your Appeal
You should use form DAB-101 to appeal. Your appeal may also be made in writing. Your written appeal must include:
- the beneficiary's name;
- the beneficiary's health insurance claim number;
- the item or service in dispute;
- the date of the item or service;
- the date of the ALJ’s decision; and
- your name and signature, and, if applicable, the name and signature of your representative;
You must send a copy of the ALJ’s decision or dismissal order with your appeal.
How to File an Appeal
Your appeal must be filed, i.e. received by the Council, within 60 days after you receive the ALJ’s decision or dismissal order. The Council will assume that you received the ALJ’s action five days after the date on the decision or dismissal order, unless you show that you received it later. If you file the appeal late, you must show that you had good cause.
Mail the appeal to:
Department of Health and Human Services
Departmental Appeals Board, MS 6127
Medicare Appeals Council
330 Independence Ave., S.W.
Cohen Building, Room G-644
Washington, D.C. 20201
Or you may fax the appeal to (202) 565-0227. If you send a fax, please do not also mail a copy. You must send a copy of your appeal to the other parties and indicate that all parties, including all beneficiaries, have been copied on the request for review. For claims involving multiple beneficiaries, you may submit a copy of the cover letters issued or a spreadsheet of the beneficiaries and addresses who received a copy of the request for review.
If you have questions about the Council, you may call (202) 565-0100.