How do I file an appeal to a Medicare claim?

Dr. Michael Roizen, MD
Internal Medicine

To file a claim with Original Medicare, review your Medicare Summary Notice (MSN), the really detailed and sometimes hard to understand statement you receive every three months. Circle the item you’re disputing and state the reason why. Include your Medicare number and phone number on the MSN. Make a copy before mailing it to the Medicare contractor listed on the form and file it in a safe place, but not too safe -- you want to make sure you remember where you put it!

You must file the appeal within 120 days of the date you get the MSN, and you should receive a response within 60 days. If you hit a road block, don’t give up. You can escalate the appeal. Keep all of your letters and support documentation through each stage of the process.

If you have a Medicare prescription drug plan, follow the appeal instructions in your “Notice of Denial of Medicare Prescription Drug Coverage.” Other Medicare health plans will include appeal instructions in the coverage and benefits material they send to you each year. You can also contact the plan directly to find out the details.

For more help filing an appeal, 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.