How to Appeal a Medicare Coverage Denial

File an appeal if Medicare denies a service or treatment you believe should be covered — many appeals win.

In this guide (5 steps):

1.Read the denial notice carefully
2.Ask your doctor for a support letter
3.Fill out the Redetermination form
4.Mail the appeal and keep copies
5.Wait for a decision

Read the denial notice carefully

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When Medicare denies a claim, they mail you a Medicare Summary Notice or a plan denial letter. This paper tells you exactly what was denied, why, and the deadline to appeal (usually 120 days).

Ask your doctor for a support letter

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Call your doctor's office and ask them to write a short letter explaining why this service is medically necessary. Most offices will do this for you, and it is the single most important thing for winning.

Fill out the Redetermination form

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Download Form CMS-20027 from medicare.gov or call 1-800-MEDICARE to request one by mail. Fill it in with your Medicare number, the denial details, and why you think it should be covered.

Mail the appeal and keep copies

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Mail the form, the doctor letter, and a copy of the denial notice to the address on your denial. Send it by certified mail so you have proof it arrived. Keep a copy of everything for yourself.

Wait for a decision

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Medicare has 60 days to respond. If they still deny, the notice will tell you how to file the next level of appeal. Free help is available from your State Health Insurance Assistance Program (SHIP) — call 1-877-839-2675.

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If Medicare (or a Medicare Advantage plan) denies payment for a treatment, hospital stay, or prescription, you have the right to appeal. Many people give up after the first denial, but about half of all appeals end up being paid.

The appeal is free, and there are five levels. Most people win at the first or second level if they include a letter from their doctor explaining why the service is medically needed.

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