If you are a Medicaid recipient and file an appeal for the denial of a service you may receive a letter or phone call informing you that you have been referred to Medication Mediation.
Medicaid Mediation is the first step in the appeal process for Medicaid benefits. Participation is voluntary.
How Medicaid Mediation works:
- Once we receive a referral from the state, The Mediation Center will contact you to find out if you’d like to participate. We have a limited number of days to schedule mediation and ask that you be as flexible as possible so that we can schedule your mediation before the deadline.
- Medicaid recipients never pay for this service – it is funded by the State of North Carolina.
- Mediation usually takes place on the telephone, and generally takes 30 minutes to an hour. In some cases, we can arrange for mediation to take place face-to-face.
- The Medicaid recipient or their representative meet on the phone with someone from the Department of Health and Human services. This person has expertise in the area of health care related to the appeal.
- A neutral mediator is also on the call. The mediator’s job is to explain the process, work on understanding the situation, and ensure that everyone has a productive conversation. The mediator does not make suggestions or decide the outcome and is not a judge.
- Mediation is an informal conversation with a non-judgmental mediator to help clarify and ensure that everyone has the opportunity to share what’s important. While presenting evidence isn’t part of the mediation process, it can be useful to have information related to the appealed service handy. This might include information from your doctor, dates of procedures, medications you take, etc.
- If there are other people you feel should participate, such as your lawyer, doctor, caseworker, or friend, please let us know when we are scheduling so that we can find a time that works for everyone. It is especially important to let us know beforehand if you will have a lawyer present.
- The purpose of mediation is to see if the people involved can work out a solution that everyone agrees to. You do not have to agree. Even if you don’t agree, you may learn useful information about why the service was denied and how you might move forward.
- If you aren’t satisfied with the outcome of the mediation, you can choose to continue on with your appeal. The next step is a hearing with an Administrative Law Judge. The judge will hear from you and from the Department of Health and Human services and will make a decision about the appeal.
- If you are satisfied with the outcome, you can choose to withdraw your appeal and you will not need to continue to a hearing.
For other questions, contact Amy Neshat at (828) 251-6089 x 210.
Please note that the only way to use Medicaid Mediation is to file an appeal for denial of a Medicaid service with the Office of Administrative Hearings.