What is 'Good Cause' for a Late Medicare Appeal?
Missing an appeal deadline can be a source of significant stress, but it does not always mean your case is closed. Under Medicare regulations, you may still be able to file your appeal late if you can demonstrate you had "good cause" for the delay.
This guide will help you understand what "good cause" means and provide you with a clearer path forward if you have missed a deadline.
What is 'Good Cause' for a Late Filing?
"Good cause" is a valid, compelling reason that prevented you from submitting your appeal on time despite your best efforts. It is intended to account for situations that are genuinely beyond your control.
Examples of circumstances that may qualify as good cause include:
Serious Illness: If you or a family member had a serious illness or injury that prevented you from filing the appeal.
Natural Disasters: Delays caused by a natural disaster, such as a hurricane or flood, that disrupted mail service or your ability to access the necessary documents.
Misleading Information: If you relied on incorrect or misleading information provided by Medicare, a contractor, or a representative that caused you to miss the deadline.
Significant Mail Delays: Documented and significant delays in receiving your denial notice through the mail.
How to Request a 'Good Cause' Exception
If you are filing an appeal late and believe you have good cause, you must:
Submit Your Appeal in Writing: The request to file late must be included with your appeal itself.
Clearly Explain the Reason for the Delay: You must provide a clear, written explanation of the circumstances that caused you to miss the deadline.
Provide Documentation: Whenever possible, submit documentation to support your claim (e.g., a hospital record, a letter from a physician, or a news report about a natural disaster).
It is important to remember that each case is reviewed on an individual basis, and simply forgetting to file a document usually does not constitute good cause. While this option exists, the best practice is always to file your appeal as soon as possible after receiving a denial notice.