What can I do if my medicaid claim is denied?

On Behalf of | May 15, 2020 | Elder Law |

Medicaid is a health care program that takes care of basic healthcare needs. This program is available to you in the U.S. if you are low-income, disabled, or over 65. If you apply for Medicaid and receive a notice of denial, this can be confusing and you may wonder how to proceed. 

Keep reading for more information on how to appeal a Medicaid denial. 

Reasons for Medicaid denials 

Even if you qualify for Medicaid, there are several reasons you may receive a denial. According to FindLaw, several things can go wrong during the application process. For example, if necessary documents are missing, that may trigger a denial. The person reviewing the claim might make a mistake and deny a valid claim as well. Additionally, if there is any questionable movement of money, this could also result in a Medicaid denial. 

Appealing a Medicaid denial 

Your denial notice will give you general instructions for requesting an appeal. In certain cases, you may be able to submit your request for appeal electronically, but it is wise to keep a written copy for your records. Georgia’s Medicaid office will set a date for the hearing and send you information regarding the time and location. Keep in mind that you can view the state’s file to help you prepare for the hearing. Following this hearing, you will receive a letter detailing the court’s decision. If your appeal is successful, you will receive notification of your enrollment. In these cases, Medicaid is usually retroactive. If your appeal is unsuccessful, however, you will receive details on how to appeal the decision further and the reason for the denial. 

FindLaw Network