Humana denied skilled-nursing or rehab coverage or payment?
Start with the reason on Humana's notice
The written notice should explain what service was refused and why. It may say the member met therapy goals, no longer needs a skilled level of care, or can receive care in another setting. The appeal should answer the actual reason on that notice with facts supported by the clinical record.
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) may fit the Level 1 reconsideration we prepare and certified-mail for $179. A denial before admission may need expedited review instead. 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 when the other coverage criteria are met. Recourse connects the reason Humana gave to the relevant standards and documented facts, using a curated Medicare library, then verifies the supported standard packet against your documents before mailing.
How Recourse helps
- 1. Upload your denial notice. We read it and identify which appeal applies — free.
- 2. We confirm whether it is a supported standard appeal. Urgent QIO notices receive free fast-appeal help; unsupported notices are not sold the mail service.
- 3. For a supported standard appeal, 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 $179 — if you choose to mail it.
- 4. If you choose the service, we certified-mail it. The appeal is verified against your documents, 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 65 days to request Level 1 reconsideration. A Notice of Medicare Non-Coverage (NOMNC) has a much shorter QIO fast-appeal deadline, and a pre-service denial may qualify for expedited review. The instructions on your notice control.
- 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 $179 include?
- Preparing your appeal letter from a curated library of Medicare regulations, pre-filling your CMS-1696 appointment form, a verification pass against your documents, 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 pass verification checks against your documents before anything is mailed. Drafts are provided for your review and are not legal or medical advice.