Federal agency ยท Indian Health Service
Indian Health Service Purchased/Referred Care: appeal a denial
How American Indian and Alaska Native patients ask the Indian Health Service to reconsider a denial of payment for care received away from an Indian Health Service or tribal facility.
Know before you go
Purchased/Referred Care pays for care away from an Indian Health Service or tribal facility. The main page says it is not an entitlement and a referral does not mean the care will be paid. A denial must come in writing with the reasons, and the page quotes a federal rule that gives 30 days from receipt of the notice to ask for reconsideration or to appeal; check your notice, which controls. Tribal facilities may differ, so contact your facility.
- Cost
- Not stated. The page lists no fee.
- Where
- Nationwide
- How to start
- Read your written denial for the reasons, then send a written request for reconsideration or appeal to your Service Unit Director, stating your grounds and attaching any new information.
- Have ready
- Your written denial notice; Your reasons in writing; Any new information not sent before
Where this comes from
- Provider
- Indian Health Service
- Source we read
- https://www.ihs.gov/prc/appeal-process/
- Date we read it
- . This is not a fresh check.
- Date the provider printed
- Not displayed
- What we checked
- We read the provider's public page. We have not verified availability, eligibility or outcomes for any individual.
Other starting points
- Program or service
Beneficiary and Family Centered Care Quality Improvement Organizations: find yours
The Medicare contractors that handle fast appeals when hospital or other care is ending too soon, and complaints about the quality of care. Each state is assigned to one of two organizations.
From Centers for Medicare & Medicaid Services
- Program or service
California Department of Managed Health Care: Independent Medical Review
California's regulator for managed care plans reviews denials of medical services, emergency payment and experimental treatment through Independent Medical Review. One form starts either a review or a consumer complaint.
From California Department of Managed Health Care
- Program or service
Center for Medicare Advocacy self-help materials
Downloadable self-help toolkits for Medicare denials involving home health care, outpatient therapy and skilled nursing facility care, from a nonprofit law organization. The page describes materials, not a helpline.
From Center for Medicare Advocacy