Not Covered

These denials mean Medicare has determined the service falls outside your plan’s coverage. Appeal prospects vary widely depending on whether the exclusion is absolute or based on specific circumstances.

• Medicare Benefit Limit Reached: What to Do Next
  Medicare says you have reached the maximum covered days or dollar amount for a service. Learn about benefit periods, lifetime reserve days, and your remaining options.
• Medicare Denied a Free Preventive Service
  Medicare denied or charged you for a preventive service that should have been free. Learn which preventive services are covered, why this happens, and how to fix it.
• Medicare Denied Claim: Covered Under Different Part
  Medicare denied your claim because the service should be billed to a different part of Medicare (A, B, C, or D). Learn why this happens and how to get it resolved.
• Medicare Denied Claim: Wrong Care Setting
  Medicare denied your claim because the service was provided in the wrong care setting. Learn about place-of-service requirements, observation status, and how to appeal.
• Medicare Denied Drug Coverage (Part D Formulary)
  Medicare Part D denied coverage for your medication. Learn about formulary exceptions, tier exceptions, the coverage determination process, and how to appeal the denial.
• Medicare Denied Medical Equipment (DME) Claim
  Medicare denied your durable medical equipment claim. Learn about DME coverage rules, certificate of medical necessity requirements, and how to appeal the denial.
• Medicare Says Another Insurance Should Pay First
  Medicare denied your claim because another insurer is listed as primary payer. Learn about coordination of benefits, Medicare Secondary Payer rules, and how to resolve it.
• Medicare Says This Service Is Not Covered
  Medicare denied your claim because the service is not covered under your plan. Learn why this happens, whether you have appeal rights, and what to do about the bill.