DI 45005.900 Reconsideration Notice for ESRD Health Insurance Coverage
Upon receipt of your request for reconsideration, we had your claim independently
reviewed by a special group. All the evidence in your case has been carefully evaluated;
this includes the medical evidence and the additional information received since the
original decision. On the basis of the evidence and your statements, it has been determined
that the previous determination was proper under the law.
To qualify for Medicare coverage on the basis of chronic kidney disease, it must be
medically determined that a course of dialysis or kidney transplant is required for
treatment of such disease and the person is receiving the required treatment. In addition,
to be entitled, the individual must meet certain insured status (work) requirements
under applicable provisions of the Social Security or Railroad Retirement Acts or
be entitled to a monthly social security benefit or railroad annuity (or be the spouse
or dependent child of a person who meets such insured status requirements or who is
entitled to a monthly benefit).
(Provide Rationale for Denial) [1]
If you believe that the reconsideration determination is not correct, you may request
a hearing before an administrative law judge of the Office of Hearings Operations
(OHO). If you want a hearing, you must request it not later than 60 days from the
date of this notice. You may make your request through any social security office.