What is Medicare Reconsideration?


When you start to talk about health insurance or Medicare it is likely that you will get some unkind looks and the story will end fast.  It is important to offset this by learning something about the process and how it will work if things aren’t concluded.  You need to know how the process works when you get a claim and what happens if you don’t agree with it.

To appeal a decision made by Medicare there is a 5 level appeals process that is available to you and all Medicare members.  If you feel that some procedure you have had was medically necessary then you will start the appeals process.  Medicare defines it as follows:

“You can ask for a redetermination (first appeal level) from the contractor that handles Medicare claims and a reconsideration (second appeal level) from a Qualified Independent Contractor (QIC). If you disagree with the QIC’s decision you can appeal to an Administrative Law Judge (ALJ). If you disagree with the ALJ’s decision you can appeal to the Medicare Appeals Council (MAC). If you disagree with the MAC’s decision you can file an appeal in U.S. district court.”


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