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According to the KFF Survey of Consumer Experiences with Health Insurance , 10% of Medicare beneficiaries experienced denied claims in the past 12 months, for care they expected to be covered. The good news: if you are denied coverage by Medicare, you have the right to appeal the decision. The bad news: The same survey reported that 69% of consumers whose claims had been denied didn’t know they could appeal those decisions, and a large majority (85%) do not file appeals.

Here’s everything you need to know to appeal a Medicare decision. Before starting the process, consider whether your appeal is viable. “Everybody’s situation is different,” says Jen Teague, director for health coverage and benefits at the National Council on Aging .



“It’s worth appealing if a person truly believes they have a medically necessary need, or they’re going to be at risk if they’re discharged earlier than they think they should be, or they need specific care or treatment.” Teague also strongly recommends having a conversation with the physician who provided the service. “Does the doctor believe this is something the patient needs, and is the doctor willing to write a letter to include in the appeal with additional information to help make that case? If so, that is very important in the potential success of the appeal,” says Teague.

Appeals to Medicare may seem intimidating and complicated, which may be why 29% of calls in 2022 to the Medicare Rights Center’s National Helpl.

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