Appeals
Entries across the digest that deal with appeals.
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Health & Benefits
Medicare Appeals: The Five Levels of Review
A Medicare denial passes through five defined levels of review, two of which carry an amount-in-controversy gate, alongside separate expedited tracks for discharge and service termination.
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Health & Benefits
Medicare Advantage Denials and Organization Determinations
A Medicare Advantage plan decides coverage through an organization determination, and a denial it upholds must be sent on to an independent review entity without the enrollee filing again.
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Health & Benefits
Social Security Disability: Application, Denial, and Hearing
A disability claim runs through a five-step test at up to five levels of review, from a state agency determination to federal district court, with the burden shifting at step five.
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Health & Benefits
ERISA Disability Claims and the Administrative Record
An employer disability plan governed by ERISA is usually won or lost during the internal appeal, because the record closes there and the court reviews what the file already contains.
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Education & Youth
Borrower Defense and Closed School Loan Discharge
Borrower defense discharges a federal loan for school misconduct; closed school discharge covers a school that shut down mid-program. Different facts, different proof, different pitfalls.
