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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
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Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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Our Medicare Advantage Claim appeals used to be adjudicated

Customer Question

Our Medicare Advantage Claim appeals used to be adjudicated by C2C. C2C is no longer functioning. How are those C2C appeals currently being handled?
Submitted: 1 year ago.
Category: Legal
Expert:  Law Educator, Esq. replied 1 year ago.

Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

Since your plan is not using C2C for appeals, the appeal goes to your plan for level 1 appeals and if you do not get a favorable decision from the plan, then they must send you notice as to the new independent review company and their address to submit your level 2 appeal. If their new independent review company denies your appeal, they must send you the information as to the administrative law judge appeals process for your area of the state and then you file your level 3 appeal to them. The next appeal, level 4, goes directly to Medicare Appeals Council. Finally, the level 5 appeal goes to the US District Court.

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