How long do I have to appeal a Medicare denial?

For Original Medicare, you generally have 120 days from the date on your Medicare Summary Notice to file the first appeal (a redetermination). Medicare Advantage and Part D plans run on faster clocks, often 60 days, and offer an expedited appeal when waiting could harm your health. Always check the deadline printed on your own denial notice, because it governs your case.

What are the odds an appeal actually works?

Better than most people expect. A large share of denials are overturned on appeal, and many are simple coding or paperwork errors rather than true coverage decisions. The people who win are usually the ones who file on time and include the missing piece the insurer asked for, so it is worth doing even when it feels daunting.

Do I need a lawyer to appeal a denial?

Usually not for the first levels. Most appeals are won with a clear letter, your doctor's supporting note, and the records that back up the request. For large dollar amounts or repeated denials you can bring in a lawyer or a patient advocate, but start with the free appeal process first.

How to fight an insurance or Medicare denial (a calm, step-by-step guide)

A denial letter is one of the most stressful pieces of mail a family can get, and it is written to sound final. It usually is not. Many denials are reversed on appeal, and a good share of them are simple errors, a wrong billing code, a missing note from the doctor, a service that needed approval first. Here is how to work through it calmly and give your appeal a real chance.

1. Read the letter for two things

Before anything else, find these on the denial notice (it may be called an “Explanation of Benefits,” a “Medicare Summary Notice,” or a “Notice of Denial”):

The exact reason for the denial. It is usually a short phrase or a code: “not medically necessary,” “out of network,” “needed prior authorization,” “not a covered benefit.” This tells you what you have to overcome.
The deadline to appeal, and where to send it. This is the single most important date in the whole process. Miss it and a winnable case can be lost. Circle it.

If the reason is vague, call the number on the letter and ask them to explain, in plain words, why the claim was denied and what specific document would change the decision.

2. Gather your evidence

Build a small folder (paper or a file on your computer) with:

The denial letter itself.
The bill or claim in question.
Your doctor’s notes that support why the care was needed. A short “letter of medical necessity” from the prescribing doctor is often the deciding piece.
A record of the symptoms, readings, or doses that led to the care. This is where keeping track at home pays off: if you have logged blood pressure, weight, or how a treatment was working, you can show it rather than describe it from memory.

A calm, private app like Salve is built for exactly this. It keeps medications, vitals, and a day-to-day journal in one place, so when you need to prove a pattern (your readings really were high, the doses really were taken) the history is already there.

3. Write a short, clear appeal letter

You do not need legal language. State plainly:

Who you are and the claim or member number.
That you are appealing the denial dated [date].
Why the care was needed, in one or two sentences.
What you have attached (doctor’s note, records, the readings).
A clear ask: “Please reverse this denial and cover this service.”

Keep it to one page. Attach the evidence. Send it the way the letter tells you to, and keep a copy of everything, including proof of when you sent it.

4. Let a calm guide help with the paperwork

This is the part that wears families down: the codes, the benefit language, the back-and-forth. Inside Salve, the companion Sage can help you make sense of a denial letter or an Explanation of Benefits in plain language, and walk you through the steps of appealing. It does not replace your doctor or a lawyer, but it can take the fog out of the forms so you know what to do next.

5. Escalate if the first answer is still no

If the first appeal is denied, you usually have more levels:

Original Medicare has five appeal levels, including an independent review and, eventually, a hearing before a judge.
Medicare Advantage and Part D plans move to an independent review organization if the plan upholds its own denial.
Private insurance typically offers an internal appeal and then an external review by an independent third party, which the insurer must abide by.

Each step has its own deadline on the paperwork you receive. The families who succeed are simply the ones who keep going and keep their records straight. If a denial is urgent (a needed medication or a hospital discharge you disagree with), ask specifically for an expedited or fast appeal.

You are allowed to push back, the process exists for exactly this reason, and a clear, well-documented appeal is often all it takes.