In the Medicare program, this was formerly referred to as the appeal process . If a patient disagrees with any decision about health care services or if Medicare does not pay for an item or service, the initial Medicare decision may be reviewed again using this process. It has five levels: (1) redetermination (telephone, letter, or CMS-20027 form); (2) hearing officer (HO) hearing or reconsideration; (3) administrative law judge (ALJ) hearing; (4) Departmental Appeal Board review; and (5) judicial review in U.S. District Court.