The Notice Router
The paper in your hand, what it means, your route and your deadline, on one table.
MYO part of Money You’re Owed
A denial is a decision, not the end of the process
Your Medicare Advantage plan said no. The rules give you a way back.
Letters, deadlines and phone scripts for prior-authorization denials, claims denied after care, early discharge from rehab or hospital, and drug denials. Each one cites the federal rule your plan has to follow.
Get the kit for $29
Every appeal is free to file, and free help exists.
Your plan, 1-800-MEDICARE (1-800-633-4227) and your State Health Insurance Assistance Program (SHIP, shiphelp.org) all help at no cost. This kit gets your appeal written and sent faster.
For members of Medicare Advantage (Part C) plans, including plans with drug coverage. Rules checked 23 October 2026 against 42 CFR Parts 422 and 423, the Federal Register, CMS.gov and Medicare.gov.
$29
one-time payment
Printable PDF, browser version and appeal-log spreadsheet
- Notice Router and Deadline Clock
- Eight fill-in appeal and request letters
- Doctor’s office worksheet
- Fast-appeal card for early discharge, with a phone script
- Escalation ladder, Part D drug route and complaint routes
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30-day money-back guarantee If you are not satisfied, email [email protected] within 30 days of purchase for a full refund—no questions asked. Keep the files.
Where people get stuck
“They approved it. I had the procedure. Then they denied the claim.”
Medicare Advantage members run into the same walls: a prior authorization denied as “not medically necessary”, a doctor’s letter that changed nothing, a parent moved out of rehab after a couple of weeks. It’s easy to stop at the first “no” without knowing which notice you’re holding, which deadline is running, or that some denials don’t follow the federal rules every plan must follow.
1
An approval should hold.
If your plan approved care in advance, or while you were receiving it, it can’t later deny coverage for lack of medical necessity. It can reopen the approval only for good cause or suspected fraud. 42 CFR 422.138(c)
2
Your doctor can make the plan hurry.
When a physician says waiting could seriously jeopardize your health, the plan must expedite. A fast decision is due within 72 hours. 42 CFR 422.570, 422.572, 422.584
3
For medical care, Level 2 is automatic.
If your plan upholds its denial, it has to send your case to an independent reviewer. You don’t file anything. Drug denials work differently, and the kit covers that route too. 42 CFR 422.592
How it works
Notice → Clock → Route.
1
Find the notice
Integrated Denial Notice, “Important Message from Medicare”, “Notice of Medicare Non-Coverage”, a drug-plan letter, or no answer at all. Each starts a different process.
2
Start the clock
7 days for most prior-auth decisions, 72 hours for a fast one, 60 days to appeal, and a noon deadline when rehab or home-health care is ending. Write the dates down.
3
Take the route
Send the matching letter to the right reviewer: your plan, the Quality Improvement Organization or the Independent Review Entity. The free helpers are named at every step.
See the pages before you buy
Three real pages from the kit.
Every rule is cited to the Code of Federal Regulations, the Federal Register, CMS.gov or Medicare.gov. Updated for the 2026 changes: the 7-day prior-auth clock, the specific-reason requirement, plan scorecards, and the new Part C independent reviewer (C2C Innovative Solutions, for appeals received from 1 May 2026).
“You approved it, then denied it”
A fill-in letter for a claim denied after the plan approved the care, with what the rule does and does not cover.
Leaving too soon?
Hospital discharge and skilled nursing, home health or rehab endings: who to call and by when.
What’s inside
Ten working documents. Each has one job.
One printable PDF (US Letter, 39 pages), a browser version, and a spreadsheet appeal log. Use only the pieces that fit your notice.
Notice Router
The paper in your hand → your route and deadline.
Deadline Clock
Every date at every level, on one sheet.
Letter Pack: 8 fill-in letters
Standard appeal · fast appeal with the doctor’s sentence · claim denied after care · “You approved it, then denied it” · request for the specific reason, criteria and case file · expedited grievance · late appeal with good cause · new-member 90-day treatment transition.
Doctor’s Office Worksheet
What the plan must weigh, the sentence that triggers a fast decision, and what to watch for in a “peer-to-peer” call.
Leaving Too Soon card
Hospital discharge, skilled nursing, home health and rehab fast appeals, with a phone script.
Escalation Ladder
Levels 1–5, who decides, the deadlines, and the $200 hearing threshold (2026).
Drug denials (Part D)
The different route, including the step where you must file.
Complaints and your plan’s scorecard
Grievances, the Medicare complaint form, and how to find your plan’s published “approved after appeal” rate (new in 2026).
Bonus: 09 Denial-Notice Decoder and 10 Appeal Log
What the common denial phrases mean, plus a printable and spreadsheet log for every call, letter, date and reference number.
Straight answers
What this kit can and cannot do.
“Isn’t Medicare help supposed to be free?”
Yes. Filing an appeal is free, and your State Health Insurance Assistance Program (SHIP) gives free one-to-one counselling. The kit says so on its first page and sends you there. It is for people who want the letters drafted, the deadlines worked out and the rules cited tonight, without waiting for an appointment.
“My doctor already sent a letter and it was still denied.”
That happens at the first decision. The kit shows what the plan must consider, how to ask for the specific reason and the criteria it used, and how, for medical care, a denial upheld at Level 1 goes to an outside reviewer automatically.
“Will this get my claim paid?”
We can’t promise any result, and nobody honest can. The kit helps you make sure your appeal is on time, complete, and sent to the right place.
“Is this legal or medical advice?”
No. These are self-advocacy templates and plain-English explanations of federal Medicare rules. For a complex case, talk to your SHIP or a licensed attorney.
“What if my life or health is at risk right now?”
Don’t wait for a download. Ask your doctor to request an expedited decision, and call 1-800-MEDICARE (1-800-633-4227).
“Does it cover my plan?”
It covers Medicare Advantage (Part C) plans, including those with drug coverage. It does not cover Original Medicare claims, Medigap, PACE, Medicare Cost plans, or plans that combine Medicare and Medicaid into one plan.
On a GLP-1 drug? See the GLP-1 Appeal Kit and the free Medicare GLP-1 Bridge guide first.
Your notice. Your deadline.
Turn the denial notice into a dated, cited appeal this week.
Find the notice, write down the deadline, send the matching letter to the right reviewer, and keep a clean record if you need the next level.
$29
one-time payment
The Medicare Advantage Appeal Kit
- Printable PDF, browser version and spreadsheet log
- Eight fill-in letters
- Deadline clock and fast-appeal card
- Escalation, Part D and complaint routes
30-day money-back guarantee If you are not satisfied, email [email protected] within 30 days of purchase for a full refund—no questions asked.