If you’ve received a Medicare denial letter recently, you’re not alone. Many seniors are surprised to find that certain tests, treatments, or services they thought were covered by Medicare end up being denied. While frustrating, the good news is that Medicare coverage denials are not final. You have the right to appeal, and understanding how to do it properly can make a big difference in your outcome.
Medicare denials often happen due to administrative glitches, incomplete documentation, or confusion about coverage limits. For instance, if your doctor didn’t use the correct coding when submitting the claim, it might be rejected even if the service is typically covered. Also, Medicare may deny coverage if it believes a service is not medically necessary. But you don’t have to accept that verdict without a fight—especially when your health is on the line.
The appeals process begins with carefully reviewing the Medicare Summary Notice (MSN) you receive, which explains what was denied and why. From there, you can submit a written request for a “redetermination” to the Medicare Administrative Contractor listed on your MSN. Include any supporting documents from your doctor that justify the medical necessity of the service. This first step must usually be taken within 120 days, so it’s vital to act quickly.
Appealing may sound daunting, but it’s far from a lost cause. In fact, many appeals are successful, especially when beneficiaries are persistent and provide solid evidence. You don’t need an attorney, but you can ask a loved one or a representative to help you. And if the first level of appeal fails, don’t give up—there are four more levels, including a hearing with an administrative law judge.
Ultimately, the Medicare appeals process is about advocating for your health and ensuring the benefits you’ve earned are honored. While the paperwork can be a hurdle, the system is set up to give you multiple chances to present your case. Stay informed, stay organized, and don’t let a denial letter discourage you. Persistence and preparation can turn a “no” into a “yes.”