You, your representative, or a physician may request a fast Medicare Advantage appeal. If a physician supports the request and states that the standard timeframe creates the required health risk, the plan must expedite the review.
How to request expedited review
Contact the plan using the appeal telephone number, fax, portal, or other channel in the initial denial notice. An expedited request may be oral or written. Identify the denied item or service, explain the health risk of waiting, and ask the physician to contact the plan or provide supporting information when possible.
How quickly the plan must decide
For an expedited pre-service or Medicare Part B drug reconsideration, the plan must decide as quickly as your health requires and no later than 72 hours after receiving the request. The federal rules allow limited extensions in some cases, but the plan must explain the extension and your rights.
What happens if the plan refuses to expedite
The plan must transfer the request to the standard appeal timeframe, give prompt oral notice, and deliver written notice within 3 calendar days. The notice must explain the right to file an expedited grievance and the right to ask again with physician support.
When another fast-appeal route applies
If a hospital, skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice gives notice that covered services are ending, follow the immediate-review instructions and deadline on that notice. That BFCC-QIO process is different from the ordinary level 1 plan reconsideration described here.
A request for payment for a service already received normally uses the standard payment timeframe rather than an expedited health review.
Official sources
- Medicare.gov — appeals in Medicare health plans
- CMS — Medicare Advantage plan reconsiderations
- eCFR — expedited reconsiderations