Medicare Advantage Denied Your Care? The 4 Appeal Rights Written Into the Rules

In 2024, Medicare Advantage insurers received nearly 53 million prior authorization requests and denied 4.1 million. Of the denials that were appealed, 80.7% were overturned — but only 11.5% were ever appealed. This video walks through the four appeal rights written into Medicare's own rules: the plan must use Medicare's coverage criteria (an HHS Inspector General audit found 13% of denials met them); the level 1 appeal — 65 days to file, 30 days for the plan to answer, 72 hours if your doctor supports an expedited request (42 CFR 422.570) — and the automatic second level the plan doesn't control; the fast appeal when a hospital, skilled nursing facility or home health agency is ending your care; and the 90-day transition rule when you switch plans mid-treatment. Plus "Gerald" — two denials, one method — and the free help that sells nothing. Source on the screen for every number. Subscribe so the next rule reaches you before you need it:    / @owedafter65   📌 CHAPTERS 0:00 53 million requests · 80.7% of appeals win · 11.5% ever appeal 0:48 Why the plan won't walk you through it 1:33 What a denial is (organization determination) 2:45 Right 1 · The plan must use Medicare's coverage rules (OIG: 13%) 4:21 Right 2 · The level 1 appeal: 65 days · 30 days · 72 hours · the doctor's lever (42 CFR 422.570) 6:07 Automatic level 2 — and levels 3 to 5 7:18 Right 3 · The fast appeal when care is being cut off 9:39 Right 4 · The 90-day rule when you switch plans 10:39 The odds are the argument (51% – 95.5%) 11:26 "Gerald": two denials, one method 13:06 Free help · appoint a representative 13:37 A denial arrives — what to do, in order 14:26 Recap: 4 Medicare Advantage appeal rights 15:00 Before the letter goes in a drawer 📎 SOURCES (every number in this video) • 2024 prior authorization: ~53 million requests, 4.1 million denied (7.7%), 11.5% appealed, 80.7% overturned; range by insurer 51.0%–95.5% — KFF, January 2026: https://www.kff.org/medicare/medicare... • Post-acute care denial rates 2024 (LTCH 65%, inpatient rehab 54%, SNF 12%, overall under 8%) — KFF, July 2026: https://www.kff.org/medicare/medicare... • 99% of MA enrollees in plans requiring prior authorization — KFF, June 2026: https://www.kff.org/medicare/medicare... • HHS OIG (April 2022): 13% of denied prior authorization requests met Medicare coverage rules; 18% of payment denials met rules — https://oig.hhs.gov/reports/all/2022/... • Appeals in Medicare health plans: 65 days to file; 30/60/7 days; 72-hour fast appeal; automatic level 2; levels 3–5; 2026 federal-court minimum $1,960 — https://www.medicare.gov/providers-se... • Expedited organization determinations (physician support → must expedite; no punitive action) — 42 CFR § 422.570: https://www.law.cornell.edu/cfr/text/... • Fast appeals (Important Message from Medicare; Notice of Medicare Non-Coverage; BFCC-QIO; observation status) — https://www.medicare.gov/providers-se... • Filing an appeal (plan must tell you in writing; SHIP; representative) — https://www.medicare.gov/claims-appea... • 2024 Medicare Advantage final rule (CMS-4201-F): Medicare coverage criteria; 90-day transition; approvals valid for the course of treatment; utilization management committee — https://www.cms.gov/newsroom/fact-she... 📞 OFFICIAL, FREE HELP SHIP (State Health Insurance Assistance Program): 1-877-839-2675 · https://www.shiphelp.org Medicare: 1-800-MEDICARE (1-800-633-4227), 24/7 · https://www.medicare.gov/talk-to-someone ———————————————————— This channel is educational. It is not medical, legal, insurance or financial advice; I don't sell insurance and have no stake in any plan. Rules and deadlines can change — confirm your own case with the official sources above. "Gerald" is a composite example, not a real person. If someone you know just got a denial letter, send them this before it goes in a drawer. 📧 remindmeinfo1@gmail.com