Appeals

Medicare appeals process in Colorado

If Medicare or your plan denies a claim or service, you have the right to appeal. Here's how the process works.

The 5 levels of Medicare appeals

LevelWho reviewsDeadline
1. RedeterminationYour plan or Medicare contractor120 days from denial
2. ReconsiderationQualified Independent Contractor (QIC)180 days from Level 1
3. ALJ HearingAdministrative Law Judge60 days from Level 2
4. Medicare Appeals CouncilDepartmental Appeals Board60 days from Level 3
5. Federal CourtU.S. District Court60 days from Level 4

How to start an appeal

When you receive a denial (called a Medicare Summary Notice for Original Medicare, or an Explanation of Benefits from your MA plan), it will include instructions for filing an appeal. The most important thing is to act quickly — you have 120 days for the first level, but earlier is better.

Getting help with appeals in Colorado

  • Colorado SHIP: Free counseling and appeal assistance — 1-888-696-7213
  • Disability Law Colorado: Legal help for Medicare appeals — 303-722-0300
  • Senior Medicare Patrol (SMP): If you suspect fraud or improper billing — 1-800-503-5190

Have questions about Medicare in Colorado?

Talk to a licensed Medicare agent — it's free.

Find a Medicare Agent

You can also visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for help with plan choices.