Medicare Advantage Enrollee Appeals

Skilled Nursing Facility, Home Health Agency, Outpatient Rehabilitation Facilities

Medicare Advantage enrollees have guaranteed rights and protections. If you are receiving care in a skilled nursing facility, from a home health agency or from a comprehensive outpatient rehabilitation facility and the Medicare Advantage Organization decides the care is no longer needed or should no longer be covered, you will receive an advance notice called a Notice of Medicare Provider Non-Coverage at least two days before coverage is terminated.

If you do not think the Medicare Advantage Organization should stop covering the services, the notice explains how you can request an appeal. This request MUST be made before noon the day after you receive the notice.

To request an appeal, call TMF at 1-800-725-8339. You may reach TMF seven days a week, including holidays. Calls received after business hours will be returned the next day.

When you request an appeal, TMF will review your case to determine if the Medicare Advantage Organization should continue to pay for your care.

Please share this information with your family.

For more information on Medicare, please call the Medicare Helpline at 1-800-MEDICARE (633-4227).