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Medicare Appeals

First Level Appeal

I want to request an appeal (redetermination) because I disagree with a coverage or payment decision from Medicare. 1st level of the appeals process.

Medicare First Level Appeal Form

Second Level Appeal

I want to request an appeal (redetermination) because I disagree with a coverage or payment decision from Medicare. 1st level of the appeals process.

Medicare Second Level Appeal Form

Third Level Appeal

I want to request a hearing by an administrative law judge (ALJ) because I'm not satisfied with the decision made during the 2nd level of my appeal.

Medicare Third Level Appeal Form