Medical Reasons

These denials happen when Medicare decides the service wasn’t medically justified based on the information provided. Many of these denials can be successfully appealed with supporting documentation from your doctor.

• Medicare Denied Claim as Experimental Treatment
  Medicare denied your claim because the service is considered experimental or investigational. Learn why this happens, your appeal options, and what steps to take next.
• Medicare Denied Claim as Not Medically Necessary
  Medicare denied your claim because the service was not considered medically necessary. Learn why this is the most common denial reason and how to appeal successfully.
• Medicare Denied Claim: Diagnosis Not Covered
  Medicare denied your claim because your diagnosis is not on the list of covered conditions for this service. Learn why this happens and what your appeal options are.
• Medicare Denied Claim: Not Appropriate for Condition
  Medicare denied your claim because the service was deemed not appropriate for your diagnosis. Learn why this happens, your appeal options, and what you can do next.
• Medicare Denied Claim: Not Improving (Maintenance)
  Medicare denied your claim saying you are no longer improving. Learn about the Jimmo v. Sebelius settlement that protects maintenance therapy coverage and how to appeal.
• Medicare Denied Claim: Too Many Visits or Services
  Medicare denied your claim because you exceeded the allowed number of visits or services. Learn why frequency limits exist, your appeal options, and how to respond.
• Medicare Denied Claim: Wrong Level of Care
  Medicare denied your claim because you did not meet the criteria for the level of care you received. Learn about observation vs. inpatient status and how to appeal.