How to appeal a Humana Medicare Advantage skilled nursing (SNF) denial
Why Humana SNF denials happen
Humana is one of the largest Medicare Advantage insurers, and like its peers it manages post-acute care — skilled nursing and rehabilitation length of stay — closely. Coverage terminations frequently arrive mid-stay, citing that the member has “met their goals,” no longer needs a skilled level of care, or could be served in a lower-cost setting. These decisions are often made on paper, by the plan, without a fresh hands-on assessment of the patient.
First: which notice did you get?
Your path turns on the notice. A Notice of Medicare Non-Coverage (NOMNC) — coverage ending on a stated date — is a fast appeal to a Quality Improvement Organization on a tight clock; our free fast-appeal helper covers that. A standard denial (Integrated Denial Notice) is the Level 1 reconsideration we prepare and certified-mail for $129. Unsure which you received? Compare the notice types, or upload yours and we'll tell you for free.
The rules that may be on your side
Under federal Medicare rules, skilled coverage does not end just because a patient has stopped improving — care needed to maintain function or prevent decline can still qualify. The most persuasive appeals connect the exact reason Humana gave to those federal standards and to the specifics of the clinical record. Recourse builds that argument from a curated library of Medicare regulations, and a Recourse team member reviews it before it is mailed.
How Recourse helps
- 1. Upload your denial notice. We read it and identify which appeal applies — free.
- 2. We prepare the appeal. A draft grounded in the Medicare rules for your situation, plus a pre-filled CMS-1696 appointment form.
- 3. You review everything.You read the draft and confirm the plan's name and mailing address before anything is sent. You only pay — a flat $129 — if you choose to mail it.
- 4. We certified-mail it. A Recourse team member reviews it, we mail it to the plan by certified mail, and you get the tracking number and a copy of exactly what was sent.
Frequently asked questions
- How long do I have to appeal a Humana SNF denial?
- It depends on the notice. A standard Integrated Denial Notice generally gives you 60 days to file a Level 1 reconsideration. A Notice of Medicare Non-Coverage (NOMNC) — saying coverage ends on a set date — is a fast appeal to a Quality Improvement Organization on a much shorter clock, not this mail process. We will identify your notice type for free before you do anything.
- Can I appeal a Humana denial myself for free?
- Yes. You can file your own Medicare Advantage appeal directly with Humana, or appoint a family member, an attorney, or a free helper like your State Health Insurance Assistance Program (SHIP). Recourse is a paid convenience — preparing, reviewing, and certified-mailing the appeal for you — not a requirement.
- What does the $129 include?
- Preparing your appeal letter from a curated library of Medicare regulations, pre-filling your CMS-1696 appointment form, a review by a Recourse team member, and certified mailing to Humana with tracking. You review the draft and confirm the mailing address before you are charged, and only if you decide to send it.
- Does Recourse promise the appeal will work?
- No. The outcome depends on the clinical record and on Humana's and the independent reviewers' decisions, which we do not control. Your fee buys preparation, review, and certified mailing of a regulatorily-grounded appeal — not a result.
- Is Recourse a law firm or connected to Humana or Medicare?
- No. Recourse is independent — not a law firm, and not affiliated with Humana, Medicare, or CMS. The plan whose denial you are appealing is the adverse party, not our partner. Nothing we provide is legal or medical advice.
Recourse is independent and is not affiliated with, endorsed by, or sponsored by Medicare, CMS, any government agency, or any health plan, including the plan whose denial you are appealing. Recourse is not a law firm and does not provide legal advice; we help you prepare and submit an appeal you are entitled to file under federal Medicare Advantage rules. Filing an appeal is your right and you may do it yourself for free. Appeal letters and statements are drafted with the assistance of AI and reviewed by a Recourse team member before any document is mailed. Drafts are provided for your review and are not legal or medical advice.