For Medicare Advantage families
Your insurance plan cut off nursing-home coverage. There's a good chance you can get it back.
The Medicare program's own inspector general found that three in four Medicare Advantage denials are overturned when appealed. Most people never appeal, because they don't know they can, or they don't know how.
We write the appeal letter for you — for free. If it looks right, we mail it certified for $129 and track what happens. If the plan denies your appeal, we refund the $129 in full.
What just happened?
Your insurance plan sent a notice with a name like NOMNC or DENC. It says they're going to stop paying for your family member's skilled nursing or rehab. The facility may have told you that you have to leave in 48 hours.
These denials are often wrong. Medicare has rules the plan is required to follow — and they frequently don't. The most common reason is that the plan cited “plateau” or “maximum benefit” language, which is no longer a legal basis for cutting off coverage under a 2013 federal court settlement called Jimmo v. Sebelius.
You have the right to appeal. The plan must review it. If they deny the appeal, an independent reviewer looks at the case next — automatically, at no cost to you.
How we help
- 1Upload the denial letter
Photo or PDF. We read it and pull out the deadline, the beneficiary's info, and exactly why the plan said no.
- 2Read your appeal letter — free
We draft a professional appeal letter citing the specific Medicare rules the plan's denial violates. It costs nothing to read. You can edit anything you want changed.
- 3We mail it certified for $129
If you give us the go-ahead, we print and send it certified mail the same day, with tracking. We also file a one-page Medicare form (CMS-1696) so the plan sends the decision to us — which means we can tell you what happened without you having to chase the plan for it.
- 4If your appeal is denied, we refund the $129
The plan has 30 days (72 hours if your case is urgent) to respond. If they uphold the denial, you get your money back — and the case is automatically sent to an independent reviewer at no cost to you, who overturns another ~35% of cases.
75%
of appealed Medicare Advantage denials are overturned, according to a 2022 report from the HHS Office of Inspector General. Only about 1 in 10 denials gets appealed in the first place.
Questions people ask first
- Are you a law firm?
- No. Recourse is not a law firm and does not provide legal advice. We're an appeal-filing service. Medicare lets non-attorneys represent beneficiaries in appeals under a process called CMS-1696. That's what we do.
- Will this hurt my relationship with my insurance plan?
- No. Appealing a denial is a routine right built into Medicare. Plans receive appeals every day. It doesn't affect coverage, premiums, or any other benefits.
- What if we have to leave the nursing home in 48 hours?
- If the notice says “expedited” or the facility is telling you a specific move-out date, there's also a faster 72-hour appeal process. We can file it the same day. Start by uploading the notice — we'll tell you which track your case is on.
- What cases do you handle?
- Right now, only skilled nursing facility (SNF) and inpatient rehab length-of-stay denials from UnitedHealthcare and Humana Medicare Advantage plans. These are the cases where our arguments are strongest and our data is best. We'll add other plans and denial types as we build a track record.
- What does my family member need to do?
- Sign one form, electronically, through the website. It takes about 30 seconds. If they can't sign themselves, call us at (347) 389-3258 and we'll walk you through the durable-power-of-attorney path.
You have time. Start by reading your appeal letter.
We'll have a draft ready in about two minutes. Nothing to pay to see it.
Upload your denial letter