Original Medicare denied an MSP demand with the wrong amount? What the rule says and how to appeal.
Checked against the current rules on September 24, 2026.
A denial for an MSP demand with the wrong amount isn't the end of the story — Original Medicare has to follow specific coverage rules, and a denial that doesn't square with those rules is exactly the kind of appeal that tends to win.
Here's what the rule actually requires, what evidence usually turns a denial around, and the deadline you're working against.
What the rule requires
How Medicare calculates a Secondary Payer recovery amount is governed by§ 411.37 Amount of Medicare recovery when a primary payment is made as a result of a judgment or settlement.. Original Medicare generally cannot apply a stricter test than what these rules require.
Questions that decide it
Before you appeal, these are the facts that usually decide whether a denial like this holds up:
Did you pay attorney's fees or other real costs to get the settlement, judgment, or award?
Have you already paid part of this demand, or was any part of it already resolved?
Does the total demand amount seem close to or larger than the settlement itself, before costs?
What a winning appeal has to show
An appeal that wins usually includes:
A statement of attorney's fees and other procurement costs you personally paid — Medicare is required to reduce its own recovery amount to reflect the real cost of getting the settlement — a demand that doesn't already reflect this is calculated wrong. (You or your family provide this.)42 CFR 411.37
The settlement, judgment, or award documentation itself — The BCRC's own math has to be checked against the actual settlement amount and date, not assumed correct. (You or your family provide this.)
Proof of any payment already made toward this demand — A demand that doesn't credit a payment already received is simply wrong on its face, separate from any procurement-cost question. (You or your family provide this.)
A written, itemized request asking the BCRC to show its own math — Asking specifically for the calculation — not just asserting the total is wrong — puts the burden on the BCRC to show its own work, and often reveals the exact error. (You or your family provide this.)
Your deadline to appeal
120 days from the date of the demand letter — 120 calendar days from when you receive it (42 CFR § 405.942(a), applied to MSP recovery), with the same 5-day receipt presumption.42 CFR 405.942
Your Medicare contractor itself then has its own clock to decide. 60 calendar days from when the BCRC receives your timely request, the same Subpart I timing the standard claims ladder uses (42 CFR § 405.950).
Questions people ask
- Can your Medicare contractor just say it's "not medically necessary" with no further explanation?
- The denial notice has to explain the basis for the decision and tell you how to appeal. If it doesn't point to a specific rule or criteria, that's itself worth raising in your appeal — you're entitled to know what standard was applied.
- What if I don't have all the evidence listed above?
- Include what you have. An appeal with partial evidence and a clear explanation of the rule still gets a real review — it doesn't need to be complete to be worth filing.
Sources — last checked September 24, 2026
- § 411.37 Amount of Medicare recovery when a primary payment is made as a result of a judgment or settlement.as of September 24, 2026
- 42 CFR 405.942as of September 23, 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.
