If you belong to a Medicare Advantage health plan and you disagree with a notice to terminate services

You have the right to request a “fast-track appeal” if you disagree with your Medicare Advantage health plan’s decision to terminate services received from

• a skilled nursing facility
• a comprehensive outpatient rehabilitation facility
• a home health agency

If the health plan decides that services should end, you will receive an advance notice called a Notice of Medicare Non-Coverage. You should receive it at least two days before your services are to end. If you feel that you still need the services and you want to request an appeal, you must contact the AFMC at 1-888-354-9100 by noon of the day before the “effective date” listed near the top of the notice.
AFMC will review your records and let you know its decision within 48 hours. AFMC cannot review any appeal calls received after the noon deadline and will refer them back to the health plan. You may request an expedited reconsideration review through the health plan.

What if I call after hours or on a weekend?

AFMC takes requests for reviews seven days a week, including holidays. If you call on a weekend or holiday, you'll hear a recording asking you to leave your name and telephone number. Please speak clearly, and an AFMC representative will call you back as soon as possible. If you call after 4:30 p.m. on weekends or holidays, your call will be returned the following morning.

What happens after I call AFMC?

An AFMC representative will ask you why you feel your services should continue and will document any information you provide. Please be prepared to answer questions or provide information. AFMC will also ask your health care provider and your Medicare Advantage plan for your medical records and any other information needed. You do not have to prepare anything in writing, but you have the right to do so.

As soon as you request a review, AFMC will tell your health care provider and Medicare Advantage plan. You will then be given a "Detailed Notice" that explains in more detail why your services will no longer be covered by Medicare.

If AFMC agrees that the health care services should no longer be covered by Medicare after the date stated in the Notice of Non-Coverage, Medicare will not pay for these services after that date. You can ask for a second review from AFMC by calling 1-888-354-9100. Make sure AFMC receives your request no later than 60 days after the notification that AFMC upheld the Medicare Advantage plan's decision. AFMC will complete the reconsideration review within 14 calendar days, or as quickly as your health condition requires.

If AFMC decides that your care should continue and Medicare should pay, you will not have to pay anything extra. But if both reviews show that your care is no longer needed, you will have to pay for any services received after the date stated on the Notice of Non-Coverage.