We file the internal appeal correctly
Internal appeals usually have a 180-day window from denial. The appeal letter has to cite medical necessity standards, plan language, and applicable parity laws. Generic 'please reconsider' letters fail.
Insurance claim denial
Most denied claims get overturned on appeal.
Insurers deny first because most people give up. The internal-appeal process is required by federal law, and the external-review process is independent. Most claims that go to external review get reversed. We file every step on time with the right medical-necessity language.
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Sound familiar?
If any of this is happening to you, we can help.
Claim denied as 'not medically necessary'
Pre-authorization denied for treatment your doctor recommended
Out-of-network exception denied
Emergency room visit denied retroactively
Mental health or substance-use treatment denied
Experimental/investigational denial that isn't actually experimental
Insurer says you missed a deadline (often a fake deadline)
How we handle it
The procedural side, on autopilot.
We escalate to external review
External reviews are conducted by independent medical reviewers, not the insurer. Most claims that reach external review are reversed. We file the external-review request and supply the doctor's statement, peer-reviewed citations, and clinical rationale.
We invoke parity law when relevant
Mental Health Parity Act and ACA non-discrimination rules force insurers to apply equivalent standards to mental-health and physical-health benefits. Many denials violate parity in subtle ways.
Example outcome
$8,400
ER denial reversed on internal appeal; medical necessity standard cited
Resolved in 47 days
Anonymized · individual outcomes vary
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Common questions
Answered.
- Sometimes. 'Good cause' extensions exist, and insurers are required to consider them. Plus, ERISA-governed plans have specific procedural protections. We assess whether your deadline situation is fixable.
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