Appeal (Health Care) Law and Legal Definition

Appeal under health care refers to a special kind of complaint made by a policy or plan holder on disagreement with certain kinds of decisions made by original medicare or by an individual’s health plan.

An appeal can be preferred in following circumstances :

when a request for health care service, supply or prescription, for which an individual is entitled, is not provided under the health plan;

when a request for payment for the health care that is already received is not met or denied by the medicare or health plan; and

when a medicare stops paying under a coverage that is already paid.