My Medicare Advantage plan denied my hospital stay as not medically necessary. How do I appeal and how fast must they decide?

Health insuranceAppealChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: GovInfo · 42 CFR 422.582 Request for a standard reconsideration · § 422.582(b) View original ↗

In short

You have 60 days from the denial notice to ask for a new look.
If you got the care, a completely favorable decision is due within 60 days.
If you still need the care, 30 days, or 72 hours if fast, unless the rule allows more time.

What this means

For a Medicare Advantage plan, the first appeal is called a reconsideration. You must ask within 60 days after you get the written denial notice [1].

How fast the plan must answer depends on what you ask for. If you ask the plan to pay for care you already got, a decision in your favor is due within 60 days of your request [2]. If you ask about care you have not got yet, a decision in your favor is due as fast as your health requires, and within 30 days [3]. A fast request that the plan approves is due within 72 hours [3]. The rule lets the plan take more time in some cases [3].

If you think you are leaving the hospital too soon, you may ask for a fast appeal. An independent reviewer decides if your services should go on [4]. Within 2 days of your admission you should get a notice called "An Important Message from Medicare about Your Rights" [4].

Your next step

Send your reconsideration request within 60 calendar days after you receive the written denial notice [1]. If you think you are leaving the hospital too soon, you may ask for a fast appeal [4].

Check it yourself

Your plan's denial notice and the Important Message from Medicare show the exact steps. The 30-day and 72-hour times above are for a standard and a fast request.

Where this comes from (4)

[1] GovInfo · 42 CFR 422.582 Request for a standard reconsideration · § 422.582(b) · checked 2026-11-06
a request for reconsideration must be filed within 60 calendar days after receipt of the written organization determination notice
[2] GovInfo · 42 CFR 422.590 Timeframes and responsibility for reconsiderations · § 422.590(b)(1) · checked 2026-11-06
Standard reconsideration: Requests for payment. ( 1 ) If the MA organization makes a reconsidered determination that is completely favorable to the enrollee, the MA organization must issue its reconsidered determination to the enrollee (and effectuate it in accordance with § 422.618(a)(2) ) no later than 60 calendar days from the date it receives the request for a standard reconsideration
[3] GovInfo · 42 CFR 422.590 Timeframes and responsibility for reconsiderations · § 422.590(a), (e)(1) · checked 2026-11-06
Except as provided in paragraph (f) of this section, if the MA organization makes a reconsidered determination that is completely favorable to the enrollee, the MA organization must issue the determination (and effectuate it in accordance with § 422.618(a) ) as expeditiously as the enrollee's health condition requires, but no later than 30 calendar days from the date it receives the request for a standard reconsidera…
[4] Medicare.gov · Fast appeals · page text · checked 2026-11-06
With a fast appeal, an independent reviewer, called a Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO), will decide if your covered services should continue … Within 2 days of your admission and prior to your discharge, you should get a notice called "An Important Message from Medicare about Your Rights

How we found this

We matched your question to 4 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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