How Do I Appeal a Medicare Claim Denial?

You open the envelope, expecting a routine update from Medicare. But instead of a paid claim, you see a notice that something wasn’t covered. A doctor visit. A lab test. Maybe a procedure you thought was all squared away.

And suddenly, you’re stuck with a bill you didn’t see coming.

Unfortunately, this isn’t uncommon. Medicare does sometimes deny claims — and when it happens, it can feel frustrating, confusing, even unfair. But here’s the part a lot of people don’t realize: you can appeal it. And in many cases, you should.

Medicare denials happen for a handful of reasons. Maybe the service wasn’t coded properly, or the doctor didn’t submit enough documentation. Maybe Medicare determined the service wasn’t “medically necessary,” even though your doctor clearly thought it was.

The point is — just because Medicare said no the first time, doesn’t mean that decision is final.

When you get your Medicare Summary Notice (that’s the one that shows what’s been paid and what’s been denied), you have 120 days to challenge the decision. And no — you don’t need a law degree to do it. You just need to send in a written request explaining why you think the claim should’ve been covered, along with any relevant medical notes or letters from your doctor.

It’s paperwork, yes — but it’s doable. And we’ve seen people win appeals, especially when the denial was based on a simple error or misunderstanding.

Sometimes people are hesitant to appeal. They don’t want to make waves. Or they assume the government’s word is final. But Medicare has this process in place for a reason. They expect people to speak up when something doesn’t seem right.

And you don’t have to go it alone. If you’re not sure where to start, we can help. We’ll walk through your denial notice with you, help you understand what it means, and if you want to move forward, we’ll help you gather the right paperwork and send it to the right place.

At the end of the day, it’s about making sure you get the coverage you deserve — and not paying out of pocket for something that should’ve been handled.

So if you ever get a denial that doesn’t sit right with you, don’t toss it aside. Let’s take a look at it together and see what can be done.