For discharge planners, social workers & care managers
When a family asks “can we fight this?” — here's something to hand them.
You've seen the moment: a Medicare Advantage plan cuts a skilled nursing or rehab stay short, you hand the family the notice, and they look at you for answers you're not allowed — or staffed — to give. Federal data says most of these denials don't survive an appeal. Almost no family files one.
The gap you see every week
When skilled nursing facility prior-authorization denials by the largest Medicare Advantage plans were appealed, 95% were overturned(HHS Office of Inspector General, report OEI-09-24-00331, June 2026 — general, historical data, not a prediction about any one appeal). Yet the great majority of denials are never appealed at all. The appeal right exists; what's missing is someone with the time to read the notice, draft the argument, and get it filed before the deadline — at exactly the moment the family is overwhelmed.
Facility staff can't fill that gap — you have a census to manage and a conflict-of-interest line to respect. Recourse exists so the family has somewhere concrete to turn that isn't a blank CMS form at midnight.
What Recourse does
- 1. The family uploads the denial notice at recourse.health — photo or PDF. We read it and identify the notice type, the deadline, and the correct appeal path. Fast-track notices (NOMNC/DENC) get routed to the QIO process on the notice, not into our paid service.
- 2. They read their appeal letter free. For standard Medicare Advantage skilled nursing and rehab denials, we draft a reconsideration letter grounded in Medicare coverage rules and the facts of their notice. Reading it costs nothing.
- 3. If they choose, we file it — $179 flat.We prepare the CMS-1696 Appointment of Representative form, verify the packet against their documents, and mail it certified with tracking. As appointed representative we receive the plan's decision and tell the family what it means.
Today we handle skilled nursing facility and inpatient rehab length-of-stay denials from UnitedHealthcare and Humana Medicare Advantage plans — the highest-volume, most time-critical lane. More plans and notice types are coming as our track record grows.
The ground rules (read these first)
- We never pay facilities or professionals for referrals — no fees, no commissions, nothing. Sharing our handout is sharing information, not steering. That keeps you, your facility, and us on the right side of every referral rule.
- Free options come first.Our handout lists the family's no-cost paths — their State Health Insurance Assistance Program (SHIP), 1-800-MEDICARE, and filing the appeal themselves — before it mentions us. Recourse is a paid convenience, never a requirement.
- The family is the client. They pay only if they choose to have us mail the appeal. We work for them, not for the facility — even though continued coverage often helps both.
- We are not a law firm and do not provide legal advice. Medicare rules let a beneficiary appoint a non-attorney representative for an appeal (CMS-1696); that is the capacity we act in. We are independent — not affiliated with Medicare, CMS, any government agency, or any health plan.
- Urgent fast appeals stay on the notice's path. If a family shows you a NOMNC with a noon deadline, the QIO phone call on that notice comes first — our site says the same thing to anyone who uploads one.
How to use this
Print a stack of the family handout and keep it wherever coverage-end conversations happen — the discharge folder, the social work office, the family meeting room. When a family asks what they can do about a denial, the handout gives them every path, including the free ones, on one page.
Questions, bulk copies, or a walkthrough for your team: support@recourse.health or (347) 389-3258.