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OTHER NAMES Medicare Peer Review Form Letter to Request a Medicare Peer Review

What is a Medicare Peer Review Request Letter?

A Medicare Peer Review Letter helps you pen a formal survey of how you were treated under Medicare. Maybe you've received a Notice of Noncoverage informing you that Medicare will no longer cover hospital care and you want that decision reviewed. A Medicare Peer Review Letter helps you get your voice heard. 
You have certain rights as a Medicare recipient. Keep the agency accountable with a Medicare Peer Review Letter. There's a Peer Review Organization (PRO) that keeps hospitals and facilities in check. Let's say you received fantastic treatment recently; you may want to praise them for how well you were treated. Maybe the treatment you received was unacceptable and you want to make sure the hospital changes their practices; either way, a Medicare Peer Review Letter lets you share your experiences. Perhaps you were just notified that Medicare won't be paying for hospital coverage in the future and you want to fight that decision. A Medicare Peer Review Letter helps you be heard and maybe even change policy.

When to use a Medicare Peer Review Letter:

  • You want to write a review, good or bad, about recent Medicare treatment or a hospital stay.
  • You got a Notice of Noncoverage and want it formally reviewed.

Sample Medicare Peer Review Request Letter

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Re: Beneficiary's Name:

Medicare No.



The purpose of this letter is to request a review of a written Notice of Noncoverage received from stating that Medicare will no longer pay for hospital care. :


I am requesting a review of the Notice of Noncoverage because


I understand that your office investigates this type of complaint. Please advise me as to the outcome of your investigation.


You may contact me if you have any questions or need additional information. or


Thank you for your assistance in this matter.







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