AHIP Practice Exam

What should Mrs. Duarte do if she disagrees with a claim determination made on her Medicare Summary Notice?

1. Contact her provider immediately

2. File an appeal within 120 days

3. Wait for the next billing cycle

4. Contact Medicare for assistance

The correct answer is: File an appeal within 120 days

If Mrs. Duarte disagrees with a claim determination made on her Medicare Summary Notice, filing an appeal within 120 days is the appropriate course of action. This process allows her to formally contest the decision regarding the claim. Medicare provides a structured appeals process which must be initiated within a specific timeframe after receiving the notice. By submitting an appeal, she can provide additional information or clarify any misunderstandings related to the services received and their coverage. Contacting her provider immediately may seem like a sensible step for clarification, but it does not directly address the disagreement with the claim determination. Waiting for the next billing cycle would further delay resolution and does not actively engage in addressing the issue. While contacting Medicare for assistance can be beneficial for guidance and understanding her options, it doesn't substitute the need for a formal appeal if she wishes to contest the decision effectively within the specified period.