Federal agency ยท Medicare.gov (Centers for Medicare & Medicaid Services)
Medicare.gov: filing an appeal
The official Medicare page on appealing a coverage or payment decision, with separate instructions for Original Medicare, Medicare health plans and drug plans, plus fast appeals when services end too soon.
Know before you go
This is a hub that sends you to the right page for your kind of Medicare coverage, and it says there are generally five levels of appeal. Your decision notice, not this page, gives your deadline, which differs by coverage type. Medicare Advantage and drug plans must tell you in writing how to appeal. The page does not draft your appeal for you.
- Cost
- Not stated. The page is free to read.
- Where
- Nationwide
- How to start
- Pick Original Medicare, Medicare health plans or Medicare drug plans from the page, then follow the steps for the level you are on. Ask your provider for any records that make your appeal stronger.
- Have ready
- Your Medicare Summary Notice or plan denial letter; Your Medicare or plan member number; Records or a letter from your doctor
Where this comes from
- Provider
- Medicare.gov (Centers for Medicare & Medicaid Services)
- Source we read
- https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals
- Date we read it
- . This is not a fresh check.
- Date the provider printed
- Not displayed
- What we checked
- We read the provider's public page. We have not verified availability, eligibility or outcomes for any individual.
Other starting points
- Program or service
Beneficiary and Family Centered Care Quality Improvement Organizations: find yours
The Medicare contractors that handle fast appeals when hospital or other care is ending too soon, and complaints about the quality of care. Each state is assigned to one of two organizations.
From Centers for Medicare & Medicaid Services
- Program or service
California Department of Managed Health Care: Independent Medical Review
California's regulator for managed care plans reviews denials of medical services, emergency payment and experimental treatment through Independent Medical Review. One form starts either a review or a consumer complaint.
From California Department of Managed Health Care
- Program or service
Center for Medicare Advocacy self-help materials
Downloadable self-help toolkits for Medicare denials involving home health care, outpatient therapy and skilled nursing facility care, from a nonprofit law organization. The page describes materials, not a helpline.
From Center for Medicare Advocacy