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How can I appeal a Medicare coverage denial?

Dr. Michael Roizen, MD
Internal Medicine

It depends on what type of coverage you have.

If you have Original Medicare (Parts A and B), you can appeal a Medicare coverage denial by following the directions on your Medicare Summary Notice (MSN). The MSN is the statement you receive every three months that shows the services you received and what Medicare paid. Circle the item or service that you are disputing and explain why it should have been covered. Sign the MSN, and send it to the Medicare contractor identified. If you don’t want to use the MSN appeal information, you can write an appeal letter. Include your name, Medicare number, service or item being disputed, and why it should have been covered. Make sure you sign it and provide contact information. You should receive a response within 60 days of filing an appeal.

If you have Medicare Advantage, you will have to look at the information in your specific plan or contact your plan directly.

If you have Part D drug coverage, you can appeal in writing, by providing your name, Medicare number, details of the item being disputed, and why it should have been covered.

If you have more questions or would like more help, contact your State Health Insurance Assistance Program (SHIP).

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.