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What can I do when Medicare refuses to pay for a claim?

Dr. Michael Roizen, MD
Internal Medicine

If Medicare refuses to pay a claim, you should call your doctor’s office to make sure they submitted the correct information. Sometimes, it’s just an oversight or human error that leads to a denial of coverage.

If the claim was filed correctly but your insurance refuses to pay, you can file an appeal, also called a redetermination. Depending on the type of coverage you have, the appeals process will be slightly different and there might even be different levels of appeal. Look through the details of your plan or contact your plan’s provider. If you still have more questions or need 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.