Understanding Your Skilled Nursing Facility (SNF) Care Denial
Skilled nursing facility denials have exploded, especially in Medicare Advantage plans. Between 2019 and 2022, SNF denials increased 9-fold, often driven by AI algorithms rather than clinical judgment. The good news: studies suggest the majority of appealed SNF denials are overturned, but few patients appeal. You have rights — use them.
Common Reasons for Denial
- ! Patient no longer meets skilled care criteria
- ! Custodial care only — not skilled nursing
- ! Discharge to home is appropriate
- ! Maximum benefit reached
- ! Prior authorization expired
How We Help
We help you document why skilled nursing care remains medically necessary, including specific skilled services needed (wound care, IV medications, PT/OT, complex medication management) and risks of premature discharge.
Some Types of Evidence We Can Use For Supporting Your Appeal
✓ Premature discharge from skilled nursing facilities is associated with higher hospital readmission rates.
✓ Medicare guidelines require coverage when skilled nursing or rehabilitation services are needed on a daily basis.
✓ Continued SNF care is medically necessary when the patient requires skilled services that cannot safely be provided in a less intensive setting.
✓ Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care
While You're Fighting Your Denial
Talk to your provider about these options that might help bridge the gap:
→ Home health care with visiting nurses may be an option if you have adequate support at home.
→ Some long-term acute care hospitals (LTACHs) provide a higher level of care if SNF isn't sufficient.
→ Ask about swing bed programs at community hospitals which combine acute and SNF-level care.
Patient Advocacy & Support Organizations
These organizations provide education, support, and advocacy for patients:
Center for Medicare Advocacy ↗
Nonprofit providing legal resources for Medicare coverage issues including SNF care.
Frequently Asked Questions
Ready to Fight Your Skilled Nursing Facility (SNF) Care Denial?
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Disclaimer: Fight Health Insurance is not affiliated with, endorsed by, or partnered with any pharmaceutical manufacturer, healthcare provider, medical device company, or patient assistance program. All information provided is for educational and informational purposes only and does not constitute medical or legal advice. Please consult with your healthcare provider regarding treatment options and with your insurance company regarding coverage decisions.