The plan didn't answer by its own deadline
Checked against the current rules on September 18, 2026.
The plan's own deadline to decide passed with no decision recorded. Under Medicare's rules, that silence is legally treated as if the plan denied the appeal again — and the plan is required to forward your case to an outside reviewer automatically, without you having to ask.
Here's exactly what it means for your appeal, and what to do about it.
What this means
This is one of the most common places a family gets stuck — not because the appeal was denied, but because nobody told them what happens when the plan simply stops responding. Under the rule, silence past the deadline isn't a dead end; it's treated exactly like another denial, and the case keeps moving without you having to file anything new.
It's worth calling to confirm the forward actually happened rather than assuming it did. Plans are required to do it automatically, but a phone call that gets you a real case number at the Independent Review Entity is worth more than waiting and hoping.
What to say
Here's what actually moves this forward:
Call the plan and ask for the case number it used to forward your appeal to the Independent Review Entity (C2C Innovative Solutions).42 CFR 422.590
If the plan says it hasn't forwarded the case, tell them it was required to under 42 CFR § 422.590 once its own deadline passed.
If the plan still won't act, file a grievance with the plan — a grievance is a complaint about the plan's conduct, separate from the appeal itself.
File a complaint with 1-800-MEDICARE so there's a federal record of the delay.
What to expect
The plan or C2C should confirm a case number for the forwarded appeal. A grievance gets its own written response from the plan, separate from your appeal.42 CFR 422.564
Who to contact
National contacts for this situation:
C2C Innovative Solutions — Medicare Part C Independent Review Entity (IRE) (partcappeals.c2cinc.com/)
Medicare.gov complaint form (www.medicare.gov/my/medicare-complaint)
Medicare Beneficiary Ombudsman (via 1-800-MEDICARE) — 1-800-633-4227 (www.cms.gov/center/special-topic/ombudsman/medicare-beneficiary-ombudsman-home)
Your state's SHIP counselor and BFCC-QIO — free, found on the Get Help page below.
This doesn't reset your case
Whatever brought you to this page is a situation the appeal process already accounts for — it's not a sign the case is broken or that you're starting over. The same level structure, the same rule-based reasoning, and the same deadlines already in motion for your case keep applying.
If you want the full picture of how the appeal levels fit together and where a case like this sits in that sequence, that's covered on its own page.
Families deal with this kind of detour more often than the standard version of the process suggests — the straightforward path from denial to letter to decision is common, but it's far from the only real path a case takes.
Whatever the situation, the next real step is usually a phone call — to the contact listed above, or to your state's free counseling program — not another form to fill out on your own.
Sources — last checked September 18, 2026
- 42 CFR 422.564as of September 18, 2026
- 42 CFR 422.590as of September 18, 2026
Related
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By CaseWhy Appeals editorial. See how this content is produced. Not legal advice. Not affiliated with or endorsed by Medicare, CMS, or any health plan. A product of CaseWhy LLC.
