Mental health and Medicare appeals

Mental health appeals

All coverage determinations that result in a denial, reduction in coverage request, or a failure to provide or make payment (in part or in whole) for a benefit contain instructions for a member appeal. Members may contact Member Services for more information.

We resolve most non-Medicare Advantage standard appeals within 14 to 30 days. Medicare Advantage pre-service reconsideration requests are decided within 30 days and post-service reconsideration requests within 60 days. Medicare Advantage Part D standard redetermination requests are processed within 7 days.

We respond to Medicare Advantage and non-Medicare Advantage expedited appeals within 72 hours from their receipt. However, some contracts specify different time frames and appeal processes.

You may request a standard appeal on the member’s behalf with written permission from the member. If you are the treating provider, you may request an expedited appeal without member permission when the standard appeal timelines (7 to 60 days) would significantly jeopardize the member’s health. See right to an appeal for more information.

Medicare appeals

Kaiser Permanente's appeal process for Medicare Parts C and D conforms to Medicare guidelines. Both you and the member will receive a copy of the appeal process with the notice of coverage denial or limitations.