Level 5 Appeals
If you disagree with your Medicare Appeals Council (Council) Level 4 decision and the amount in controversy is at least $1,560 (2017) (or $2,000 for reconsiderations issued by a Quality Improvement Organization), you may file a civil action in your local Federal District Court. The notice of decision from the Council will give you information about filing a civil action. This is the last level of appeals – Level 5
Please note that your request must be filed with the Federal District Court within 60 days of receiving the Medicare Appeals Council decision.
Please note that the Office of Medicare Hearings and Appeals is responsible only for the Level 3 claims appeals and certain Medicare entitlement appeals and Part B premium appeals. OMHA is not responsible for levels 1, 2, 4, and 5 of the appeals process. OMHA provides additional information on other levels of appeals to help you understand the appeals process in a broad context.