How do I appeal a Medicare denial?

You have the right to appeal any Medicare coverage denial. File your appeal within 60 days of receiving your denial notice. Your plan must respond within 30 days for standard appeals, or 72 hours for expedited (urgent) appeals.

What is a Medicare prior authorization appeal?

A prior authorization appeal is a formal request to your Medicare Advantage plan to reconsider a coverage denial. You can appeal denials for DME equipment, specialist visits, hospitalizations, imaging, and prescription drugs.

How long does a Medicare appeal take?

Standard Medicare appeals must be decided within 30 days. Expedited (urgent) appeals must be decided within 72 hours. If your plan denies your appeal, you can escalate to an Independent Review Entity (IRE).

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What was denied?

Tell us what your Medicare plan refused to cover. We'll build the right appeal letter.

Type of denial

Which equipment?

Please select what was denied before continuing.

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Which plan denied you?

Enter your Medicare Advantage or Part D plan name. This goes in the letter header.

Plan / carrier name

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Please select your plan from the list, or type your full plan name.

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Tell us about the denial

The more you share, the stronger your appeal letter will be.

What reason did the plan give? (optional but helpful)

Date of denial

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Upload denial letter (optional — attached for your records) 📎 Click to attach your denial letter (PDF, image, or Word doc)

Please enter the denial date before continuing.

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Your information & medical need

We'll use your name and details to personalize the letter. Medical context is optional but strongly recommended.

📝 Letter — Appellant Information

Your full name *

Date of birth (optional)

Medicare ID (optional)

Mailing address (optional)

Your medical condition or reason you need this service (optional)

Please enter your full name to personalize the letter.

Building your appeal letter…

Drafting medical necessity arguments and regulatory citations. Just a moment.

✅ Your Appeal Letter

✏️ Review for any remaining [BRACKETED] placeholders and fill them in before sending.

📈 If This Appeal Is Denied — What's Next?

1

Level 1 — Internal Plan Appeal You Are Here

File within 60 days of denial. Your plan must respond within 30 days (standard) or 72 hours (expedited, if your health is at risk).

2

Level 2 — Independent Review Entity (IRE)

If Level 1 is denied, your case is automatically forwarded to a CMS-contracted IRE. Decision within 60 days (standard) or 72 hours (expedited). This review is completely independent from your plan.

3

Level 3 — ALJ Hearing

If the IRE upholds the denial, request a hearing before an Administrative Law Judge. Request within 60 days of IRE decision.

Minimum: $190 amount in controversy (2026)

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Level 4 — Medicare Appeals Council

Request review by the Departmental Appeals Board within 60 days of the ALJ decision. No minimum dollar threshold.

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Level 5 — Federal District Court

Last resort — federal judicial review of your case. File within 60 days of the Appeals Council decision.

Minimum: $1,900 amount in controversy (2026)

Important: This tool provides general guidance and does not constitute legal or medical advice. Appeal letter templates are starting points — customize with your specific details before sending. Consult a SHIP counselor or healthcare attorney for complex appeals. We cannot guarantee appeal outcomes. Filing a strong, well-documented appeal is the best way to maximize your chances.