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 Inpatient Rehab: Rehab Hospital vs. Skilled Nursing
  Your Medicare Advantage plan denied admission to an inpatient rehabilitation facility (acute rehab) and says a skilled nursing facility is enough. Learn Medicare's IRF criteria — including the 3-hour therapy rule — and how to appeal fast.
• Discharged From Medicare Too Soon? How to Appeal
  Medicare or your plan says leave the hospital/SNF but you don't feel ready? A free fast appeal can keep you covered — here's your deadline and how to file.
• Medicare Advantage EOB Shows a Denial You Don't Recognize
  If your Medicare Advantage Explanation of Benefits shows a denied claim after surgery or a procedure, this guide explains what it means, why it happens, and how to appeal.
• 'Not Medically Necessary' Denial: How to Appeal
  Medicare denied your claim as 'not medically necessary' (CARC CO-50). The 'reasonable and necessary' standard, your 120- or 65-day appeal deadline, and the 5-step appeal.
• 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: 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 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.
• Medicare Denied: Service Didn't Match Diagnosis
  Medicare denied the service because it didn't match your diagnosis on record. This denial is often appealable — here's what your doctor needs to submit.