For Medicare Advantage families
Your insurance plan cut off nursing-home coverage. You may still have appeal options.
Upload your Medicare Advantage denial letter. We draft a regulatorily grounded appeal for free to review, then mail it certified for $129 only if you tell us to. If the Level 1 appeal is denied, we refund the $129 fee.
We help you turn the denial notice into a structured appeal packet. You can read the draft for free before deciding whether to have us mail it.
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.
Medicare Advantage plans must apply Medicare coverage rules when reviewing these notices. Some denials rely on “plateau” or “maximum benefit” language, even though Medicare guidance recognizes that skilled care can still be covered when it is needed to maintain function or prevent deterioration.
Your notice controls the deadline and filing path. Some notices go through a fast BFCC-QIO process first; others use the plan's standard reconsideration process. We help you read the notice and prepare appeal language for the right path.
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 structured appeal letter using Medicare Advantage coverage rules and the facts from your denial. It costs nothing to read, and 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 Level 1 is denied, we refund the $129
If the Level 1 decision denies the appeal, we refund the fee after we receive or verify the decision letter. Some adverse or partially favorable Medicare Advantage decisions are forwarded for independent review automatically.
Most people do not appeal
Many Medicare Advantage denials are never appealed, even though appeal rights are built into the process. Recourse helps families prepare the written appeal instead of starting from a blank page.
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, follow the fast-appeal instructions on the notice right away. Uploading here does not by itself contact the QIO or plan, but we can help you prepare appeal language for review.
- 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