Denied by Medicare? Start Here — Why I Wrote DENIED.

If you are reading this, there is a good chance a Medicare or Medicare Advantage denial letter is sitting on your kitchen table right now. Take a breath. A denial is not the final word — it is the opening move in a process that is stacked against people who give up, and surprisingly winnable for people who do not.

The number the insurers hope you never learn

When Medicare Advantage prior-authorization denials are appealed, the majority are overturned. A 2024 KFF analysis of federal plan data found that roughly 80% of appealed Medicare Advantage prior-authorization denials were overturned. And yet only a small share of denied prior-authorization requests are ever appealed at all — about 11.5% in that same 2024 KFF analysis. The system counts on your silence.

That gap — between how often appeals win and how rarely people file them — is why this site exists, and why I wrote DENIED. — The Insider's Manual to Winning Your Medicare Advantage Appeal.

What to do the day a denial arrives

• Read the notice carefully. Find two things: the specific reason for the denial, and your appeal deadline. Everything else is noise.
• Mark the deadline. First-level Medicare Advantage appeals must be filed within 65 calendar days from the date on your denial notice — count from the date printed on the notice, not from the day it arrived. File early; do not let the clock run out while you decide.
• Call your doctor's office. Tell them the claim was denied and ask them to support an appeal. A letter of medical necessity from your doctor is the single strongest piece of evidence you can file.
• Put everything in writing. Keep copies of the denial notice, your appeal, and every letter and phone call (date, time, name of the person you spoke to).
• File the appeal — even a simple one. A short, on-time appeal preserves your rights. You can add evidence as it comes in.

What this site will teach you

Every week we publish a new plain-English guide to some corner of the denial-and-appeal maze: prior authorization, appeal deadlines, expedited (72-hour) appeals, letters of medical necessity, skilled nursing and home health cutoffs, drug denials, and how to get free help from your State Health Insurance Assistance Program (SHIP).

You do not have to be an expert — you have to be on time

Appeals are won by ordinary people who follow the process, meet the deadlines, and put the right evidence in the file. The rules, dollar amounts, and dates change from year to year, so always confirm the current details for your situation at Medicare.gov or by calling 1-800-MEDICARE.

This article is general education, not legal or medical advice. Medicare rules, deadlines, and dollar amounts change; confirm the current details for your situation at Medicare.gov or by calling 1-800-MEDICARE. MedicareClaimDenied.com is not affiliated with or endorsed by Medicare, CMS, or any insurer.