C. Denied inpatient hospital claims

Provide the beneficiary with the basic information as to what constitutes covered services. When emergency services in a nonparticipating hospital are involved, explain the medical necessity and accessibility requirements. If, after the explanation, the beneficiary indicates that they are dissatisfied, assist them in filing a reconsideration request.

(If a patient receives items or services in excess of, or more expensive than, those for which payment can be made, payment is made only for the reasonable cost of the covered items or services.)