Basic (03-86)
DI 45001.100 Notification of Equitable Relief—ESRD Termination (Dialysis), DOTH is Earlier Than
DOTS—Beneficiary Not Notified Timely
The law provides that Medicare coverage, based on kidney disease, will end with the
last day of the 12th month after the month in which a course of dialysis is ended
unless, before that point, a transplant is received or regular dialysis is resumed.
Since you discontinued dialysis in (month /year) , your Medicare entitlement should have ended the last day of (month/year) . Your hospital insurance coverage did end the last day of (month/year) . However, because the work needed to end your coverage was not done on time, the
law permits your medical insurance coverage to remain in effect through the last day
of (month /year) .
If you believe that this determination is not correct, you may request that your case
be reexamined. If you want this reconsideration, you must request it not later than
60 days from the date you receive this notice. You may make your request through any
social security office.
Please read the enclosed leaflet for a full explanation of your right to question
the determination made on your claim. If you should again begin a course of dialysis
or receive a kidney transplant, please contact any social security office about filing
a new claim for Medicare coverage.
Enclosure: HCFA-10128