Your Medicare Claim Was Denied. Here's How to Appeal.

The letter you have

Prior authorization rejected. A service deemed not medically necessary. A hospital pushing discharge before you are ready. Whether you have Medicare Advantage (Part C) or Original Medicare (Parts A & B) — every denial is appealable, and the deadline is real.

At stake: $1,000 – $50,000+

What we do with it

We read the letter. We explain it in plain English. In about 30 seconds you'll know where you stand — and what to do next.

Analyze My Denial — Free →

No account needed · Results in about 30 seconds · Free to start

Medicare Advantage vs. Original Medicare — Know Which You Have

Your appeal path depends on which Medicare you have. Both are supported — the process is different.

✓ Full appeal packet — $39

Medicare Advantage (Part C)

Benefits through a private insurer — Humana, UnitedHealthcare, Aetna, Blue Cross, etc. Your card shows the plan name, not just "Medicare." These are private plan appeals — same process as other health insurance.

✓ Document preparation — $39

Original Medicare (Parts A & B)

Coverage directly from the federal government — your card says "Medicare." We prepare appeal documents for you to review, sign, and file. Not a law firm nor an authorized representative. See acknowledgment below before uploading.

Three Common Medicare Denials — and Why They Are Overturnable

These patterns appear in Medicare Advantage plans and Original Medicare. The appeal arguments are similar — the filing steps differ.

Prior Auth Denied

76 Viability

Prior authorization rejected

"After medical review, your request for prior authorization for [service] has been denied. The requested service does not meet our clinical criteria for coverage."

Why it overturns: Medicare Advantage plans must cover everything Original Medicare covers — they cannot apply stricter medical necessity rules than CMS. For Original Medicare, the same clinical documentation gaps are challengeable on appeal. A well-prepared letter with physician support addresses the criteria the reviewer actually applied. Urgent cases can be expedited — especially while you are still in care.

Not Medically Necessary

80 Viability

Coverage denied as not medically necessary

"Based on our review, we have determined that the requested service does not meet medical necessity criteria under coverage guidelines."

Why it overturns: Most denials happen because documentation did not address every criterion in the applicable National or Local Coverage Determination — not because the care was unnecessary. Your physician's letter of medical necessity, addressing each criterion by name, corrects the record. This is one of the most frequently overturned denial types in both Medicare Advantage and Original Medicare.

Discharge / Status Dispute

74 Viability

Hospital pushing discharge or classifying you as "observation"

"You are being notified that Medicare coverage for your inpatient hospital services will end on [date]. You have the right to appeal this decision if you believe you still need inpatient care."

Why it overturns: Observation vs. inpatient status determines whether Medicare Part A covers your stay and subsequent skilled nursing care. File while you are still in the hospital. Original Medicare: request an immediate expedited appeal with the BFCC-QIO. Medicare Advantage: follow your plan's expedited appeal process. The hospital cannot discharge you or bill you while the review is pending.

Here's How It Works — Three Simple Steps

From denial letter to appeal-ready in about 3 minutes. Medicare deadlines are strict — start now.

Upload Whatever You Received

Take a photo or upload a PDF — that's really all it takes.

Your Medicare Advantage EOB, Original Medicare denial notice, prior authorization rejection, discharge notice, or QIC letter. PDF or a phone photo works. Your document is handled securely and deleted if you do not continue. No account needed.

We Read It and Explain It

Within seconds — plain English, no Medicare jargon.

We identify the denial basis, give you a viability score from 0 to 100, explain your appeal rights at every level, and flag your deadline. Completely free.

Your Complete Appeal Packet Is Ready

Formally written, ready to file — for $39.

Medicare Advantage: Level 1, Level 2, and external review letters. Original Medicare: redetermination, QIC, and ALJ-level documents. One payment. No additional charge if the first appeal is denied.

How to appeal a Medicare denial — start free

Upload your Medicare denial, prior authorization notice, or discharge letter — Medicare Advantage or Original Medicare. In under a minute you'll know exactly where you stand — and your appeal deadline.

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Free to analyze · $39 complete appeal · No subscription · All escalation levels included

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