Medicare Denial Guide

Understand your Medicare denial in plain English. Learn why your claim was denied, whether it's worth appealing, and exactly what to do next.

Browse by Category

Your claim was denied because of a question about your Medicare enrollment, coverage dates, or coordination with other insurance.

Medical Reasons

Your claim was denied because Medicare questioned the medical basis for the service — such as medical necessity, frequency, or clinical documentation.

Patient Responsibility

These aren't denials — they're the portion of the bill that's your responsibility under Medicare's cost-sharing rules, like deductibles, coinsurance, and copays.

Special Situations

Denials that don't fit neatly into other categories — timely filing, coordination of benefits, bundled services, and other specific circumstances.

Your claim was denied because of a problem with how it was submitted — missing information, duplicate submission, or coding errors.

Your claim was denied because the service isn't covered under your Medicare plan — either by policy exclusion, benefit limits, or coverage rules.

Prior Authorization

Your claim was denied because the service required advance approval from Medicare or your plan, and that approval wasn't obtained.

Provider & Network

Your claim was denied because of an issue with the provider — they may not be enrolled in Medicare, not in your plan's network, or not authorized to perform the service.