Reviews and appeals about your Medicare entitlements
If you’re affected by a decision about your Medicare entitlements, you have the right to request a review of the decision.
Your review rights
If you believe a decision about your Medicare entitlements or debts including Dental Benefit, Pharmaceutical Benefit and related payments is incorrect, you can:
- ask us to provide a full explanation of the decision - we will check the details and thoroughly explain the decision to you, giving you a chance to correct misunderstandings and present new information
- request an internal review of the decision if you still think the decision is incorrect by using the Review of decision form
You must ask for a review within 28 days of being notified of the decision about your entitlements or debt.
Further appeals following a review of decision
If you are still not happy with the review outcome, you can make a complaint to the Commonwealth Ombudsman who can look at whether our decision or actions were fair and reasonable in the circumstances.
The Ombudsman will require special reasons to investigate a complaint that is being, or has been, reviewed by the Federal Court and may choose not to investigate a complaint if rights of review to courts or tribunals exist and have not been exercised.
Read more about how to make a complaint on the Commonwealth Ombudsman website.
If you are not happy with the internal review outcome, you have the option to seek a review on questions of law under the Administrative Decisions (Judicial Review) Act 1977 to the Federal Court or Federal Circuit Court if a person is aggrieved by a decision or conduct which falls within the scope of the Act.
An application should be submitted with the Federal Court Registry within 28 days of receiving the review decision in writing, although a late application might be accepted in some circumstances.
For more information:
- contact the Federal Court Registry in your state or territory
- visit the Federal Court of Australia website
- seek legal assistance