# If the plan says no again: the independent review

Claim Back guide · updated October 19, 2026 · https://claimback.lapla.si/guides/independent-review

You don’t have to file anything. When a Medicare Advantage plan keeps its denial, in whole or in part, it must send the case to an independent reviewer that works for Medicare, not for the plan.

- **Forwarding: Automatic**, when the plan keeps its decision, even in part
- **The reviewer: C2C**, Innovative Solutions, Medicare’s Part C reviewer since May 1, 2026
- **It decides in: 30 days**, for care you’re waiting for; 60 for a bill; 72 hours if fast

## What the plan must do

The plan writes an explanation and sends the whole case file to the reviewer, within the same time it had to decide: 30 days for care you’re waiting for, 60 days for a bill, and within 24 hours of its decision on a fast appeal.

A plan that misses its own deadline is treated as having said no, and the case goes on the same way.

## Who reviews it

Medicare’s Part C independent review entity. Since May 1, 2026 that is C2C Innovative Solutions; cases it received through April 30, 2026 stay with the former reviewer, MAXIMUS Federal Services.

The reviewer sends your parent, and you if you’re their representative, a letter saying it has the case file.

## What you can still add

You can send the reviewer more information about the case. C2C must receive it no later than 10 days after you get its letter. Put your parent’s name and the appeal number on it. A family member, friend, doctor or lawyer can help you write it.

You can also ask for a copy of the case file the plan sent.

> **Watch the mail.** The 10 days start when the reviewer’s letter arrives. Open everything from the reviewer the day it comes.

## How long it takes

30 days for care you’re waiting for, 60 days for a bill, 7 days for a Part B drug, 72 hours for a fast appeal. In some cases the time can be extended by up to 14 days. If the reviewer reverses the plan, it tells the plan to pay for or provide the care.

## If the reviewer says no too

The next level is a hearing with an administrative law judge at the Office of Medicare Hearings and Appeals.

- You have 60 days to ask. The reviewer’s letter explains how.
- The amount in dispute must be at least $200 in 2026.
- After that come the Medicare Appeals Council and, for $1,960 or more in 2026, a federal district court.

## Sources

- [42 CFR 422.590 — Timeframes and responsibility for reconsiderations](https://www.ecfr.gov/current/title-42/section-422.590) (eCFR)
- [42 CFR 422.592 — Reconsideration by an independent entity](https://www.ecfr.gov/current/title-42/section-422.592) (eCFR)
- [Appeals in Medicare health plans](https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals/medicare-health-plans) (Medicare.gov)
- [Reconsideration by Part C Independent Review Entity (IRE)](https://www.cms.gov/medicare/appeals-grievances/managed-care/review-part-c-independent-entitiy) (CMS)
- [Medicare appeals and your rights](https://partcappeals.c2cinc.com/Enrollees-and-Representatives/Medicare-Appeals-and-Your-Rights) (C2C Innovative Solutions (Part C IRE))
- [Part C organization determination and appeals process (flow chart)](https://www.cms.gov/medicare/appeals-and-grievances/mmcag/downloads/managed-care-appeals-flow-chart-.pdf) (CMS)

This guide explains the published rules; it isn’t legal advice. Where a notice says something different, follow the notice.