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)
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.
(Guidance for rationales may be obtained from DI 45001.076 fill-ins (or instructions) (a) through (e).)