Request for Reconsideration of Medicare Advantage Denial
Please submit this form to make a request for reconsideration of a Medicare Advantage denial.
Because we, AmeriHealth, denied your request for coverage of (or payment for) a service, you have the right to ask us for a reconsideration (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Advantage Coverage to ask us for a reconsideration.
Expedited appeal requests can be made by phone at 1-866-569-5190 (TTY/TDD: 711).
To ensure your privacy, all information will be sent via a secure connection. AmeriHealth will not disclose any personal information to outside persons or entities unless we have written consent or unless authorized by law.