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.

Can't pay the full MSP demand? How to request a compromise for less.

Owing the full amount of a Medicare Secondary Payer demand isn't necessarily the end of it — a compromise request asks Medicare to accept less than the full amount, and it's a real, available option even though it isn't a formal appeal.

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

Less than the full amount of an MSP demand denials like this one turn on your own specific facts and documentation, not a single cited rule — the questions and evidence below are what actually decide it.

Questions that decide it

Before you appeal, these are the facts that usually decide whether a denial like this holds up:

Are you genuinely unable to pay the full amount within a reasonable period, even in installments?
Is there a real, specific weakness in Medicare's own claim to this money — for example, a dispute about the settlement's own terms — that a court might not resolve in Medicare's favor?
Is the amount in dispute small enough that the government's own cost of collecting it in full might exceed what it would actually recover?

What a winning appeal has to show

An appeal that wins usually includes:

A statement of your income, expenses, and assets — The Federal Claims Collection Act standard turns on real inability to pay in full — the same kind of specific accounting a waiver request needs, entered only at download and never stored. (You or your family provide this.)31 U.S.C. § 3711 — Collection and compromise
Any documentation of a payment-plan request or partial-payment offer already made — Showing a real, good-faith attempt to resolve the debt strengthens the case that full collection isn't realistic, one of the FCCA's own real criteria. (You or your family provide this.)

This isn't a formal appeal, and has no fixed deadline

A compromise request is a discretionary negotiation with CMS under the Federal Claims Collection Act, not an appeal — it carries no formal filing deadline, and a decision on it carries no further appeal right either way. That said, the underlying debt keeps accruing interest and moving toward referral to the Treasury Department while a compromise request is pending, so there's real value in asking sooner rather than later.

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

31 U.S.C. § 3711 — Collection and compromise

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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.