How Do I Rebut Medicaid Claim Denial?

Medicaid coverage is a federally funded, state-administered insurance program for people of low income or having a disability. The medical coverage benefits follow the same rules as other health insurance programs in that some claims and bills get denied based on program parameters. When a denial is received you should file an appeal to rebut the denial if you believe that the claim was legitimate and thus should be a covered expense.

Things You'll Need

• Case or file number at Medicaid office that handles your account
• Contact information for your Medicaid case worker
• Copies of all medical bills not paid
• Copy of the denial letter

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Instructions

• 1

  Read the denial letter and make notes regarding reasons stated why Medicaid did not approve the claim. Verify that the dates of service, your full name and your case number or account number through Medicaid is correct.

• 2

  Contact your case manager in charge of your account at the Medicaid office that services your account. Make sure to have your case number, a copy of your medical assistance card, copies of all medical bills and the denial letter handy. Ask to speak to your case manager, and if she is not available, ask to speak to a supervisor regarding your case. If you do not know the contact information for your Medicaid office, use the Medicaid office location tool available through the National Association Of State Medicaid Directors.

• 3

  Talk to the case manager or supervisor and write down the name of the person you spoke with along with all information discussed. Note the date and time of the conversation. Ask the case manager to explain why your Medicaid claim was denied. Ask to have your claim re-examined and verify that a verbal request is sufficient to start the process. Ask for a specific date to contact him again regarding the claim and make note of the date given to you.

• 4

  Write a letter stating that you are appealing the initial denial decision. Send this letter as a follow-up to your verbal request to have the case looked at again. In the letter, state the date and time of the conversation you had regarding the denial. Include pertinent information such as your full name and address, contact information including cell phone number, your Medicaid case number, a copy of the front and back of your medical assistance card and copies of all relevant medical bills and denial letters. Send the letter to the Medicaid office and keep a copy for your files.

• 5

  Follow up by telephone four to six weeks after sending the appeal letter to check on the status of your claim. Continue to talk to your case worker regarding the claim until Medicaid has provided you with a final decision including explanations as to why the claim was officially denied or the claim has been paid.