Insurance Appeals Toolkit
A calm, step-by-step toolkit for appealing denied stroke claims across Medicare, Medicaid and commercial plans.
Before you file
- Confirm the appeal deadline (often 60–180 days).
- Request the full claims file in writing.
- Gather every EOB, bill and clinical note.
Choose your route
Original Medicare
Begin with a redetermination request to the Medicare Administrative Contractor. If denied, request reconsideration from a Qualified Independent Contractor.
Medicare Advantage
File an internal reconsideration with the plan. Upheld denials automatically forward to an Independent Review Entity.
Medicaid
Request a fair hearing through your state Medicaid agency within the deadline on your denial notice.
Commercial PPO / HMO
File an internal appeal with the plan, then escalate to an external review through your state insurance department if necessary.
Build the strongest case
The single most effective document is a letter of medical necessity that ties the requested service to specific stroke deficits and the patient's rehabilitation potential. Generic letters rarely succeed; specific ones often do.
Track everything
Save submission confirmations, reference numbers and call notes. StrokeBill keeps a structured timeline of every step.