Medicare Part B Appeals Process

View Medicare  Part B Fee-for-Service Appeals Process




Medicare has a formal appeals process that is relatively easy to initiate but must be managed carefully to ensure that the appeal is optimally prepared and that timely filing deadlines are not missed. Many non-Medicare health insurers follow similar procedures.

There are currently 5 levels of Medicare Part B appeals1:

• Level 1: Re-determination

• Level 2: Reconsideration

• Level 3: Administrative Law Judge (ALJ) Hearing

• Level 4: Departmental Appeals Board (DAB) Hearing

• Level 5: Federal District Court Hearing

Each level of appeal must be completed before you are eligible to advance to the next level. In addition, there are time and dollar thresholds that must be met.