If Mrs. Duarte disagrees with a claim denial, what should she do?

When Mrs. Duarte disagrees with a claim denial, the most appropriate course of action for her is to file an appeal within 120 days. This process allows her to formally contest the denial decision made by her insurance company or Medicare and request a review of the claim. Filing an appeal within this timeframe is critical because it ensures that her case is considered in a timely manner, adhering to the guidelines established by Medicare and health insurers.

Taking action by filing an appeal shows that she is actively engaged in managing her healthcare and financial responsibilities, and it can potentially lead to a favorable outcome if her initial claim was incorrectly denied. The appeals process is structured to allow patients to advocate for themselves, ensuring that their rights are protected.

While contacting her physician for advice or submitting a complaint to Medicare may be helpful steps later in the process, they do not directly resolve the claim issue in a timely way. Waiting for the next billing cycle is not a proactive approach and could result in more complications with the claim denial, making it less likely that the issue will be resolved satisfactorily.

Thus, filing an appeal is the most direct and effective action Mrs. Duarte can take in response to her claim denial.