Medicare Appeals Good Cause for Late Filing

What if I can’t file my appeal by the deadline?

If you can’t file your appeal request in the standard time frame, you can ask for an extension. We’ll evaluate your request to determine if there’s good cause for the late filing. Good cause includes things like:   

• A serious illness prevented you from contacting the appeals reviewer
• You had a death or serious illness in your immediate family
• Important records were destroyed or damaged by fire or other event, like a hurricane, earthquake or flood
• Access to your records was affected by an emergency or disaster, like a hurricane, earthquake, snowstorm, or explosion
• The contractor or appeals reviewer gave you incorrect or incomplete information about when and how to file an appeal
• You didn’t get notice of the determination or decision
• You submitted a request to a Government agency (such as a Social Security office) in good faith within the time limit, that didn’t reach the appeals representative in time
• You needed documents in large print, Braille or another accessible format that caused a delay
• Physical, mental, educational, or other limitations (including limited understanding of English) that delayed or prevented you from filing your request on time. This may include delays because you had to get help from an outside resource (like your State Health Insurance Assistance Program (SHIP) or senior center)

How to ask for a late filing extension

If you send your appeal request after the filing deadline, you should explain why your appeal request wasn’t filed by the deadline. Send this explanation with your appeal request and include any evidence you have that shows why you need an extension.

Send your appeal request with this additional information to the address on the decision you’re appealing. For appeals submitted online, follow the directions on the decision letter.

Be sure your request meets the requirements for the type of appeal you need. Check the decision you’re appealing. It will list the requirements for the next level of appeal.

What happens next?

If the appeals reviewer approves your request for an extension, you’ll get a decision within 60-90 days depending on the level of appeal. If your request is not approved, your appeal will be dismissed. Information about how to appeal a dismissal will be included in the letter.