This request is a collaboration with Mike Gartner of Persius, an organization that provides free digital tools and data to help US consumers navigate issues with health insurance.

Medicare uses a tiered appeals process by which beneficiaries can contest denials of coverage. The second level (“Level 2”) of the five level process is known as a Qualified Independent Contractor (QIC) Reconsideration.

CMS currently maintains a publicly accessible view of a structured dataset containing Level 2 appeal outcomes for Part C and Part D (but neither Part A nor Part B). It contains the following fields:

These fields, however, represent a small fraction of the records CMS collects for each Level 2 appeal through its Medicare Appeals System. Furthermore, the online database contains only appeals decided since 2020.

For these reasons, our FOIA request 📄 seeks all database records representing Level 2 appeals for Medicare Parts A, B, C, and D, and their outcomes, minus personally-identifying information.

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