How to Appeal a Medicaid Decision

A Medicaid claim may be denied for several reasons. It could be due to services not being covered under the plan or the provider submitting a claim for a much higher amount than what Medicaid pays for the service. Either way, it is your right to appeal any decision made by Medicaid. Read on to learn how to appeal a Medicaid decision.

Instructions

• 1

  Contact your case manager. Each Medicaid recipient is assigned a case manager who can help you navigate through the Medicaid process. Let your case manager know that you wish to appeal a decision and he can help you get through the process.

• 2

  Send an appeal letter to the Medicaid appeals representative in your area. It should be addressed to the Bureau of Appeals. Some states may also give you an option to call in the appeal to their office.

• 3

  Fill out the appeals form. Most departments provide you with an appeals form for Medicaid decisions. You'll give your Medicaid information along with the reason that you are appealing the claim.

• 4

  Get a statement from your physician. A physician's statement is often required during the appeals process. The statement will give the reasons that you needed to get the service that was performed.

• 5

  Wait to hear about Medicaid's decision. Your case goes to review and the appeals department will let you know if you have won the appeal. An appeal can take up to three months to be reviewed.