Has your insurance company, Medicare or Medicaid denied you help? You don't have to take no for an answer.
How can I fight for myself?
Sometimes you have to fight to get the right health care. Speak up for yourself and your family if you need health care.
Can I get free legal help to address a health care problem?
You may get free legal help with a medical denial from Iowa Legal Aid. We help with health insurance appeals with Medicaid, Medicare and private insurance. To find out if you can get help call 1-800-532-1275 (voice or TTY) or visit Iowa Legal Aid on the web www.iowalegalaid.org.
What do I need to know if I'm denied help with a medical problem?
By knowing the rules, you can help yourself and your family when you are denied help with a medical problem. Read the information here for the type of coverage you have.
- If you are covered by a managed care organization, you need to exhaust their internal appeals procedures. After exhausting their procedures, you have 90 days to appeal. Send a letter or an Appeal and Request for Hearing form to Medicaid to ask for an appeal. You can get this form from your worker or at https://dhs.iowa.gov/dhsforms.
- Are you now getting the service that was denied or cut back? If so, the service will continue while you appeal, if you call or send in your appeal right away. You must appeal within 10 days of getting the denial.
- You have the right to see any documents in your case file or any documents that Medicaid will use at your hearing. You have a right to bring witnesses and to have someone represent you. If you lose the case, you have the right to appeal the decision.
If you disagree with a decision about your Medicare services, you can ask for an appeal. Information on filing an appeal can be found here.
Your deadline for filing an appeal depends on which part of Medicare (A, B, C, or D) you are appealing. Medicare will also process appeal requests using the information available even if it does not meet all the requirements.
- You have the right to file a grievance on a denial from a private insurance company. Your policy will tell you how to do this. You can also call your insurance company and ask them about your appeal or grievance rights. You can also go to court, but you should have a lawyer.
- If you lose your case, you can ask the Iowa Insurance Division to review the denial. Information on filing a request can be found here: https://iid.iowa.gov/external-review. The independent reviewer can decide whether the denial was right.
Where do I go with a complaint about a health care provider?
The Iowa Department of Public Health Bureau of Professional Licensure has information about filing complaints. https://idph.iowa.gov/Licensure.
Where do I go with a complaint about a nursing home?
You can file a complaint with the Iowa Department of Inspections and Appeals. Click here for more information.
Is there more help for seniors who have health questions?
The Senior Health Insurance Information Programcan answer your questions about Medicare, Medicare supplement insurance, long term care insurance and other health insurance. Call 1-800-351-4664.
What if my durable medical equipment has been lost or damaged?
Durable medical equipment providers have the flexibility to waive replacement requirements during the emergency declaration. This means the face-to-face requirement, a new doctor’s order, and a new medical necessity documentation is not required. This waiver is still in effect.
Iowa Legal Aid provides help to low-income Iowans.
To apply for help from Iowa Legal Aid:
- Call 800-532-1275.
- Iowans age 60 and over, call 800-992-8161.
- Apply online at iowalegalaid.org
If Iowa Legal Aid cannot help, look for an attorney on “Find A Lawyer” on the Iowa State Bar Association website iowabar.org. A private attorney there can talk with you for a fee of $25 for 30 minutes of legal advice.
As you read this information, remember this article is not a substitute for legal advice.