Medicare Advantage Denied Your Care or Claim? Most Appeals Win
More than 8 in 10 Medicare Advantage denials that get appealed are overturned, yet only about 1 in 9 people appeal. The plan is counting on you not to. See your options below, or have us appeal it for you.
Denied by Medicare Advantage? See your options
Two quick questions. Nothing is saved, and there is no signup.
1. What happened with your Medicare Advantage plan?
The system counts on you not appealing
In 2023, Medicare Advantage plans received about 50 million prior-authorization requests and denied roughly 4 million. Only about 1 in 9 of those denials were appealed, but of the ones that were, more than 8 in 10 were overturned (80.7% in 2024, and more than eight in ten every year from 2019 to 2024).
And many denials should never have happened. The HHS Office of Inspector General found that 13% of prior-authorization denials and 18% of payment denials by Medicare Advantage plans were for care that met Medicare’s own coverage rules. A denial is a starting point, not a verdict.
Two kinds of denial, both appealable
Prior-authorization denial
The plan refuses to approve a service your doctor recommended, before you get it. You can appeal, and request a fast decision if waiting could harm your health.
Claim / payment denial
The plan refuses to pay after you got care, which can leave you with a bill. This can be appealed too, and the bill itself can be reviewed for errors and reduced.
Your appeal rights
Medicare Advantage appeals move through several levels. You start by asking the plan to reconsider (usually within 60 days of the denial). If the plan says no, your case goes to an independent review entity, and there are further levels after that, including an administrative law judge. If waiting could seriously harm your health, you can ask for an expedited decision in as little as 72 hours.
What to do
Get the denial and the reason in writing (the plan must provide it), and note the deadline to appeal.
Ask your doctor for a letter of medical necessity and the records that support the care.
File the appeal with the plan, and request a fast decision if your health is at risk.
Keep any bill that resulted, so it can be reviewed for errors and reduced.
Prefer to start it yourself? Use our free insurance appeal letter template, which covers the deadlines and the medical-necessity language to include.
We'll appeal it for you
Appeals are technical and time-sensitive. There is usually a strict deadline to file, you often have to quote the plan's own coverage rules and policy language back to them, and it helps to attach a letter of medical necessity and the right records, then escalate through several levels if the plan says no. Miss a step and the denial stands.
CareRoute Bill Defense handles all of it: we appeal Medicare Advantage denials and underpayments, cite the coverage rules, meet the deadlines, push it through the levels, and work down any bill that resulted. It is especially helpful when you are unwell or helping an older parent.
Send us the denial or billFree to submit. You only pay if we save you money.
Frequently asked questions
My Medicare Advantage plan denied my care. Is that final?
No. You have the right to appeal, and most appealed denials are overturned. In every year from 2019 through 2024, more than 8 in 10 Medicare Advantage denials that were appealed were reversed in the member or provider’s favor.
How often are Medicare Advantage denials wrong?
A federal watchdog, the HHS Office of Inspector General, found that 13% of prior-authorization denials and 18% of payment denials by Medicare Advantage plans were for care that actually met Medicare’s own coverage rules. In other words, a meaningful share of denials should never have happened.
Why do so few people appeal?
In 2023, Medicare Advantage plans received about 50 million prior-authorization requests and denied roughly 4 million, yet only about 1 in 9 denials were appealed. Many members do not know they can appeal, or find the process confusing, so the denial stands by default.
What is the difference between a prior-authorization denial and a claim denial?
A prior-authorization denial happens before you get care: the plan refuses to approve a service your doctor recommended. A claim or payment denial happens after care and can leave you with a bill the plan will not pay. Both can be appealed.
How do I appeal a Medicare Advantage denial?
Ask your plan for the denial reason in writing, then file an appeal (called a reconsideration) with the plan, usually within 60 days. If waiting could harm your health, you can request a fast (expedited) decision. If the plan upholds the denial, it goes to an independent reviewer, and there are further levels after that.
Can CareRoute appeal it for me?
Yes. CareRoute Bill Defense appeals Medicare Advantage denials and underpayments and works to resolve the bill that resulted. It is free to submit, and you only pay if we save you money.
Related
Sources & references
This is general information, not legal or medical advice, and does not create a client relationship. Medicare Advantage appeal rules and deadlines are set by federal law and by your plan, and can change. Check your plan’s denial notice for its specific appeal instructions and deadlines. Last updated: July 2026.