If Medicare denies a claim, you have the right to appeal. The process has five levels, starting with a redetermination request to the company that handles your Medicare claims. Deadlines apply, so act quickly once you receive a denial notice.
When Medicare denies a claim, the denial letter you receive is actually your roadmap. It will tell you why the claim was denied and exactly how to appeal. Read it carefully before you do anything else.The appeals process has five levels. Most people start at level one, called a redetermination. You submit a written request to the Medicare Administrative Contractor, the company that processed your original claim, asking them to take another look. You generally have 120 days from the date on your denial notice to request this.If that doesn't go your way, level two is a reconsideration by a different independent organization. Level three takes your case to an Administrative Law Judge. Levels four and five involve the Medicare Appeals Council and federal court, though most appeals are resolved well before that point.For Part C (Medicare Advantage) or Part D (drug plans), the process is slightly different because your private insurance plan handles the first step, not Medicare directly. The same appeal rights apply, but you'll contact your plan first.A few practical tips: keep copies of everything, note every deadline, and don't give up after one denial. Many appeals succeed on the first or second try. If you want free help navigating this, a local SHIP counselor can walk you through it at no cost.
Utah's SHIP program is run through the Aging and Disability Resource Centers (ADRC). They provide free, unbiased help with Medicare appeals. You can reach them at 1-800-677-1116 or find your local ADRC office at utah.gov.
For you, this means a denial is not necessarily the final word. You have a structured, legal right to challenge it, and free help is available if the process feels overwhelming.
Our Commitment to Reliable Medicare Information
At Resting Sycamore Advisors, we work to provide accurate, current, and trustworthy information about Medicare Advantage, Medicare Part D, and Special Needs Plans.
To do that, we use data published by the Centers for Medicare & Medicaid Services (CMS), which is the official source for Medicare plan and enrollment information.
Our Medicare plan pages and comparison tools are powered by CMS datasets, including:
When possible, we link to the original CMS resources so you can review the source material directly.
We follow the CMS release schedule and update our website as new data becomes available.
We load new plan year Landscape and PBP files before the Medicare Annual Enrollment Period (October 15 through December 7). We also monitor CMS.gov for updates or revisions and refresh our content when needed.
We update enrollment and performance data as CMS publishes revised files, which are typically released monthly or quarterly.
We routinely monitor CMS announcements for corrections, reissued files, or other changes and update our pages accordingly.
Each plan page includes a Last Accessed date so visitors can see when the source information was most recently reviewed.
CMS data can be difficult to read in raw form. To make it easier to use, we format and organize the data for clarity.
This includes:
All data values come from CMS. We do not change the underlying values beyond formatting, organization, and presentation.
We keep internal records of the CMS dataset versions used on our site.
If CMS issues corrected or revised files, we update our website to reflect the latest available version.
Please keep the following in mind:
For personalized Medicare assistance, please use these official resources: