If you received a notice saying Medicare denied payment, you have the right to appeal.
An appeal is a formal request you make if you disagree with a coverage or payment decision.
Always check your Medicare Summary Notice (MSN) to see if Medicare has paid for your services and how much you may owe your provider. If your MSN says that Medicare did not pay for a service, and you think it should, call your doctor to make sure there was not a billing error before appealing.
Start your appeal by following the appeal instructions listed on your MSN or Redetermination Request form:
- Circle the denied service listed and filling out the shaded section at the end of the MSN.
- Send your appeal to the Medicare Administrative Contractor (MAC) within 120 days of the date on your MSN. (The MAC’s name and address are listed in the shaded section of your MSN.)
- This will start your appeal process. The MAC should make a decision within 60 days.
If your provider sends you a bill for this service, let your provider’s billing office know that you are in the process of appealing Medicare’s coverage decision.
If your appeal is successful, your service or item will be covered. If your appeal is denied, you can move on to by appealing to the Qualified Independent Contractor (QIC) within 180 days of the date listed on the MAC denial letter.
The Qualified Independent Contractor (QIC) may go by a different name in your area.
Follow the instructions on the Medicare Administrative Contractor (MAC) denial notice to file your appeal. The QIC should make a decision within 60 days.
If your QIC appeal is successful, your service or item will be covered. If your appeal is denied and your health service or item is worth at least $200 in 2026, you can choose to appeal to the Office of Medicare Hearings and Appeals (OMHA) level.
Follow the appeal deadlines. If you have a good reason for missing your appeal deadline, you may be eligible for a good cause extension. You should also keep a copy of all documents sent and received during the process.
(This article is taken from the Medicare Rights Center, Dear Marci newsletter; May 2026)