Medicare Advantage Reconsideration Request Letter
Builds a Medicare Advantage reconsideration request with its deadline.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Organization determination notice date
- 2026-09-10
- What was denied
- A service or item
- Enrollee name
- Pat Doe
- Member ID
- X123
- Plan name
- Example MA Plan
- Service, item or drug denied
- an MRI
- Name of enrollee or physician signing
- Pat Doe
- Request date
- 2026-09-20
Result: The request is due by November 14, 2026. 1 blank left to fill before sending.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Organization determination notice date (YYYY-MM-DD)
- What was denied
- Date the notice was received, if later than presumed (YYYY-MM-DD)
- Enrollee name
- Member ID
- Plan name
- Service, item or drug denied
- Name of enrollee or physician signing
The other 4 fields
- Ask for an expedited reconsideration
- The physician makes the expedited statement
- Asking for a good-cause extension (filed late)
- Request date (YYYY-MM-DD; blank for today)
How this is calculated
Citation
42 CFR 422.582: a written request within 60 days of receiving the organization determination, receipt presumed 5 days after its date; late only for good cause. 422.584: the expedited standard. 422.590: 30 days, 60 for payment, 7 for a Part B drug, 72 hours expedited. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.