# How to appeal a Medicare Advantage denial Claim Back guide · updated October 19, 2026 · https://claimback.lapla.si/guides/appeal-a-medicare-advantage-denial When a Medicare Advantage plan says no, the first appeal goes back to the plan itself. It’s called a reconsideration. You ask in writing, within 65 days of the date on the notice, and the plan has a fixed time to answer. If it says no again, the case moves on without you having to ask. - **Ask within: 65 days**, from the date printed on the plan’s notice - **The plan answers in: 30 days**, for care you’re waiting for; 60 for a bill; 72 hours if fast - **If it says no again: Automatic**, the case goes to an independent reviewer ## Who can ask The person enrolled in the plan, or someone acting for them. For care that hasn’t happened yet, the treating doctor can also ask on the enrollee’s behalf, as long as the doctor tells the enrollee. Start with the denial notice, and follow its directions for where and how to send the appeal. ## Acting for a parent There are two ways to have the standing to appeal for someone else. - **Be appointed.** Your parent signs Form CMS-1696, Appointment of Representative, or an equivalent written notice, and you sign it too. Plans must accept the form and can’t insist on their own. Ask the plan’s member services where to send it; the number is on the member ID card. - **Be authorized under state law.** A court-appointed guardian, someone with durable power of attorney, or a health care proxy doesn’t need the form, but has to show the legal papers. An appointment lasts one year from the day both of you have signed, and it covers any appeal filed in that year. Until a valid form is on file, the plan sends everything to your parent, not to you. ## What to send Put the appeal in writing and send it where the notice says. Include: - Your parent’s name, address and the Medicare Number on their Medicare card. - The items or services you’re appealing, the dates of service, and why you disagree. - Your name and proof that you can act for them, if you’re the one appealing. - Anything that makes the case stronger, such as a letter from the doctor. Before you write, ask the doctor or the provider for any information that would make the appeal stronger. > **It counts when the plan gets it.** An appeal counts as filed on the day the plan receives it, not the day you send it. Send it with time to spare, and keep proof of when it went. ## Standard or fast A standard appeal for care you’re waiting for gets an answer within 30 days. If waiting that long could seriously jeopardize your parent’s life, health or ability to regain maximum function, ask for a fast appeal instead. The plan then has 72 hours. If a doctor makes the request, or supports it and says the wait could cause that harm, the plan must make it fast. Fast appeals aren’t available for bills for care already received. If the plan refuses to speed it up, it moves the appeal to the standard 30 days and must tell you in writing within three days. You can ask again with a doctor’s support. ## How long the plan has - Care you’re waiting for: 30 days. - A bill for care already received: 60 days. - A Part B drug: 7 days. - A fast appeal: 72 hours. For care and services, the plan can take up to 14 more days in some cases, for example to get records from a doctor outside its network. It has to tell you in writing, and why. When the denial said the care wasn’t medically necessary, the appeal must be decided by a physician with the right expertise who had no part in the first decision. ## If the plan says no again If the plan keeps its decision, in whole or in part, or misses its deadline, it must send the case to an independent reviewer that works for Medicare. You don’t file anything. [What happens at the independent review](https://claimback.lapla.si/guides/independent-review). ## Sources - [42 CFR 422.578 — Right to a reconsideration](https://www.ecfr.gov/current/title-42/section-422.578) (eCFR) - [42 CFR 422.582 — Request for a standard reconsideration](https://www.ecfr.gov/current/title-42/section-422.582) (eCFR) - [42 CFR 422.584 — Expediting certain reconsiderations](https://www.ecfr.gov/current/title-42/section-422.584) (eCFR) - [42 CFR 422.590 — Timeframes and responsibility for reconsiderations](https://www.ecfr.gov/current/title-42/section-422.590) (eCFR) - [Appeals in Medicare health plans](https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals/medicare-health-plans) (Medicare.gov) - [Parts C & D enrollee grievances, organization/coverage determinations, and appeals guidance](https://www.cms.gov/medicare/appeals-and-grievances/mmcag/downloads/parts-c-and-d-enrollee-grievances-organization-coverage-determinations-and-appeals-guidance.pdf) (CMS) - [Form CMS-1696, Appointment of Representative](https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms1696.pdf) (CMS) This guide explains the published rules; it isn’t legal advice. Where a notice says something different, follow the notice.