


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.



Ohio residents can get free, unbiased Medicare appeal help through OSHIIP, the Ohio Senior Health Insurance Information Program. That can be especially useful if you are dealing with a denied claim, a coverage dispute, or a prior authorization issue and want help understanding the next step.

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.
Book a review with a licensed Medicare advisor.
