What if...?

Real situations that come up beyond a straightforward denial — pick yours for exactly what to do.

• The fast-appeal window has passed
• The noon-next-day deadline to request reconsideration has passed
• Your case has reached a formal hearing level
• A facility sent your bill to collections
• The MAC, QIC, or OMHA missed its own deadline
• This looks like a duplicate claim or a billing error, not a real denial
• The retrospective observation-appeal window has closed
• The amount in dispute is below the dollar minimum for a hearing
• The provider is also appealing this claim
• Your parent has both Medicare and Medicaid
• A settlement attorney is already involved
• Interest is accruing while your appeal or waiver request is pending