What your plan says. What it means. What to do next.
Plain-English help before a test, and after an ABN, a denial or a bill. Start with the one question that decides everything else.
- I have Original MedicareThe red, white and blue card
- I have a Medicare Advantage planA plan from an insurance company
Not affiliated with or endorsed by any government agency. Medterpret drafts letters and tracks deadlines. You sign and file.
Why this matters
- Medicare Advantage1 in 10prior-authorization denials are ever appealed.KFF, 2024 data.
- Medicare Advantage8 in 10of those appeals are overturned, fully or in part.KFF, 2024 data.
- Original Medicare$0is what you owe on a medical-necessity denial if the provider never had you sign a valid ABN. It's the law.Social Security Act §1879.
- Original Medicare392%average lab markup over what Medicare pays (median 250%), across 97,714 provider-service records: 2023 submitted charges vs. the 2026 Clinical Laboratory Fee Schedule.On a covered Part B lab test, Medicare pays its rate and you owe $0. The markup bites when you sign an ABN, pay out of pocket, or the claim is denied.Medterpret analysis of CMS data: 2023 Part B provider-charge data vs. the 2026 Clinical Laboratory Fee Schedule.
How it works
1Show us.
Snap a picture of the order, the ABN, the denial letter or the bill.
2See what it says.
What your plan says, in plain English. What Medicare pays. Whether it’s worth acting on, and the deadline if there is one.
3Take the next step.
A question for your doctor, a lower price, a letter you review and send, or a number to negotiate with. You sign and file.
Tools
- PrecheckOriginal MedicareCoverage and rate before the test. Upload the order and see whether the diagnosis codes match Medicare’s rules.
- Test lookupAll MedicareCoverage rules by test: which diagnosis codes Medicare accepts, and how often.
- Find a labAll MedicareLab test prices near you, online options, and a phone script to ask for a better price.
- Appeal a denialAll MedicareUpload the denial and see what it says, which appeal track it is on, and your deadline. Then a draft letter you review, sign and send.
- Check a billAll MedicareGougeStop, a Medterpret tool: upload a lab bill and see each charge next to Medicare’s rate.
- Negotiate the billAll MedicareGougeStop, a Medterpret tool: Medicare’s rate as your number, and a phone script to use it.
- Insurer scorecardMedicare AdvantagePrior-authorization denial and overturn rates by insurer, from public data.
- Claim monitoringComingOriginal MedicareWe watch your Medicare claims as they post and flag new denials. Not yet available to new members.
Ready? Tell us which Medicare you have.
- I have Original MedicareThe red, white and blue card
- I have a Medicare Advantage planA plan from an insurance company
Not affiliated with or endorsed by any government agency. Medterpret drafts letters and tracks deadlines. You sign and file.