Most denials are never appealed — and most appeals win. If Medicare said no, we're here to help you fight back.
1 in 10
Medicare claims are denied
<20%
of denials are ever appealed
70%+
of appeals are successful
Medicare has a multi-level appeals process. Here's what each level means and when to use it.
Your claim is reviewed again by a different reviewer at the Medicare contractor that initially processed your claim.
Deadline: 120 days from MSN date
We handle this level
A different contractor (QIC) reviews the decision. This is a more thorough review with new information considered.
Deadline: 180 days from Level 1 decision
We handle this level
An Administrative Law Judge (ALJ) hears your case. Requires amount in controversy of $180+ (2024 threshold).
Deadline: 60 days from Level 2 decision
We can connect you with attorneys
The Council reviews the ALJ decision. They may uphold, remand, or reverse.
Deadline: 60 days from Level 3 decision
Legal representation recommended
Federal district court review. Requires $1,780+ amount in controversy and exhaustion of other levels.
Deadline: 60 days from Level 4 decision
Requires attorney representation
Studies show that appeals at Levels 1 and 2 have the highest success rates — especially when properly documented and prepared. This is where we focus our services.
We prepare your appeal documents, cite the specific Medicare rules in your favor, and track deadlines so you don't miss them.
We prepare your appeal documents with the specific Medicare coverage rules cited in your favor.
Starting at
$299
If you have multiple denials, we offer discounted pricing for batch appeals.
Contact for pricing
Custom Quote
Understand why Medicare denied your claim and whether the denial is valid.
Find the specific Medicare coverage policies that support your case.
Write a compelling appeal that addresses the denial reasons point by point.
Make sure you file on time. Missed deadlines mean lost appeals.
Everything you need to know about Medicare appeals.
If you received a Medicare Summary Notice (MSN) with a claim marked as "Denied" or not paid, you have appeal rights. Look for the "Appeal Rights" section on your MSN. It will tell you how to request an appeal and how much time you have.
For most Medicare denials, you have 120 days from the date on your Medicare Summary Notice (MSN) to request a Level 1 appeal. Don't wait — start the process as soon as possible. Missing the deadline means losing your right to appeal.
A strong appeal includes: (1) A clear explanation of why the service should be covered, (2) References to specific Medicare coverage rules that support your case, (3) Medical records and doctor's notes supporting medical necessity, and (4) Any other documentation that strengthens your position. We handle all of this for you.
It varies by level. Level 1 appeals (redetermination) typically take 60 days, though Medicare can take up to 60 additional days. Level 2 (reconsideration) can take 60-90 days. We'll track your appeal and follow up on your behalf. We can also request expedited appeals if your health is at risk.
In some cases, yes. If you're receiving ongoing care that's being terminated, you may be able to request "premium appeal" status to continue coverage during your appeal. Your doctor's support is crucial for this. Contact us immediately if you're currently receiving care that might be cut off.
If Level 1 is denied, you can continue to Level 2 and beyond. Many people win at higher levels. We help you at Levels 1 and 2, and we can connect you with attorneys who specialize in Medicare for Level 3+ cases if needed.
Not for Levels 1 and 2. These administrative appeals don't require legal representation. Most cases are won at these levels with proper documentation. For Levels 3+ (ALJ hearings and beyond), legal representation becomes more valuable. We prepare your case for Levels 1-2 and can refer you to attorneys for higher levels if needed.
Medicare Advantage plans have their own appeal process that differs from traditional Medicare. If you have MA instead of traditional Medicare, see our Medicare Advantage Help page for details on the MA-specific appeals process.
Don't accept "no" from Medicare without a fight. Most denials that are appealed are overturned. Let us help you prepare the strongest case possible.
You have 120 days from your MSN date to file a Level 1 appeal. Don't delay.
Your Medicare Summary Notice (MSN) shows what was denied and why. Have it handy when you contact us.
We'll review your denial and tell you whether an appeal makes sense — at no cost to you.
Call us to discuss your denial. We understand the Medicare appeals process.
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