Timeline for filing a Medicare private health plan appeal (standard)

Appeal for Denial of Care	Appeal for Denial of Payment
Plan Reconsideration (Appeal)
Must be requested within 60 days of date of notice (you can request late if you have “good cause”, for example, if you were in the hospital so could not file an appeal within 60 days). Medicare private health plan has 30 days to make a decision for pre-service denials (and 14 days to gather more information if it's in your best interest). If it upholds the denial, the case is automatically forwarded to the Independent Review Entity (IRE). Amount in question does not matter.	Must be requested within 60 days of date of notice (you can request late if you have “good cause”, for example, if you were in the hospital so could not file an appeal within 60 days). Medicare private health plan has 60 days to make a decision. If it upholds the denial, the case is automatically forwarded to the Independent Review Entity (IRE). Amount in question does not matter.
Reconsideration (Review by an Independent Review Entity)
Automatic review if plan upholds denial. Amount in question does not matter. IRE has 30 days to respond for pre-service denials (and 14 days to gather more information if it’s in your best interests).	Automatic review if plan upholds denial. Amount in question does not matter. IRE has 60 days to respond for post-service denials.

	Administrative Law Judge (ALJ) Hearing
	Must be requested within 60 days. Amount in question must be at least $140 in 2013. No time limit within which to respond.
	Medicare Appeals Council (MAC) Hearing
	Must be requested within 60 days. Amount in question does not matter. No time limit within which to respond.
	Judicial Review (Federal District Court)
	Must be requested within 60 days. Amount in question must be at least $1,400 in 2013.