Insurance Appeals,Engineered to Win.
Your denial is not the final word. We build, file, and fight your appeal, backed by a senior reviewer on every file. Nothing upfront. You pay only if we win.
- 01Decode your denialVerbatim reason parsed, CARC and RARC codes, 61 denial classes
- 02Retrieve your recordsFHIR medical-record pull, ICD-10 coding, plan policy language
- 03Map the strategy140 carrier and 2026-regulation strategy modules
- 04Draft on real lawAudited CFR, statute, and case-law citations, never fabricated
- 05Gate, then sign off18-check preflight, then a senior reviewer signs off
- 06File and pursue50 states and federal external-review routing
Carrier names and logos are trademarks of their respective owners. Apellica is independent and not affiliated with any insurance carrier or carrier's appeal program.
People hand us the fight, and win it back
Real reviews from patients, caregivers, and providers we have helped.
Man I was stressed out of my mind with a $14,000 bill from an ER visit that Anthem refused to cover. I tried fighting them myself for three months and got nowhere but transferred around. Handed it over to this team and they got the whole thing overturned. Cannot thank you guys enough.
Absolute lifesavers. Cigna denied my medication pre-auth twice and I was completely stuck. This team stepped in, dealt with the portal, and got it approved in less than two weeks. If you are dealing with insurance runarounds just let them handle it.
From a provider standpoint, the automated downcoding from commercial payers has gotten out of hand. We started routing our most stubborn, aged denials to this team on contingency. The turnaround has been incredible. It is completely risk-free revenue recovery for our practice.
I was literally crying at my kitchen table looking at the stack of forms and appeal letters. Insurance companies rely on exhausting you so you just give up and pay. Giving my case to them was the best decision ever. They took all the pressure off my shoulders.
Honestly I thought it was a scam at first because they said no upfront fees. But they actually only take a percentage of what they win back for you. They recovered $6,200 on my denied surgical claim. Super transparent and professional the whole way.
They are the real deal. My insurance cut off my physical therapy sessions midway through my recovery claiming it wasn't medically necessary anymore. This team fought the decision and forced them to reinstate my benefits. Absolute game changers.
Aetna denied our daughter's specialized scan and we felt completely helpless fighting a giant corporation on our own. This team has the actual technical expertise to make them fold. Don't waste your time arguing with customer service reps, just hire these guys.
Super professional, fast, and they actually answer the phone when you call. They looked at my denial code, told me exactly what clinical data the insurer was missing, and handled the whole appeal. Reversal came through yesterday. Highly recommend!!
Very straightforward process. I sent them my EOB and the denial letters, they did a quick review, took the case, and kept me updated every Friday. No hidden catches, no surprise fees. They take their cut from the payout and that is it.
If you have been denied by your provider, do not just accept it. The insurance system is designed to make you quit. This team knows exactly how to navigate the back-end of the portals to get results. 10/10 experience.
Verified customer reviews. Individual results vary; outcomes depend on your plan, the clinical facts, and applicable law. Apellica does not guarantee any specific result.
Most denied claims stand because no one fights them.
The appeal is the leverage.
Across U.S. commercial, Medicare, and Medicaid plans (KFF).
Most denials stand by default. The vast majority remain appealable.
More than 4 in 10 denials are reversed when patients formally appeal (KFF, 2023 ACA marketplace data).
Sources: KFF analysis of ACA marketplace claims (2023). CMS marketplace transparency data.
The work, in numbers.
These are the realities of the system we work in. The figures below are drawn from published KFF research; our $0-to-start, pay-only-if-we-win terms are fixed.
Across U.S. commercial, Medicare, and Medicaid plans (KFF).
Most denials stand by default, the appeal step is the leverage.
More than 4 in 10 denials are reversed when patients formally appeal (KFF, 2023 ACA marketplace data).
Including Medicare, Medicaid, ERISA, and commercial plans.
Contingency fee, pay only if we recover. No card at intake.
Every intake, every business day.
Industry figures sourced from KFF. $0 to start, you only pay if we win.
Resolve denials at scale,on contingency.
Manufacturers, specialty pharmacies, health systems, and infusion clinics partner with Apellica to recover revenue lost to denied claims. One conversation is enough to scope the opportunity. No prep required.
The discipline behind every appeal we file.
Six commitments we hold on every case, from your first intake through the written decision from your carrier.
Secure document handling
Encrypted in transit and at rest. All documents are treated as Protected Health Information under our HIPAA aligned program.
Acknowledged within one business day
Every intake is logged, assigned, and acknowledged within 24 hours. Time sensitive matters are flagged at intake and prioritized.
Defined workflow on every matter
Each appeal moves through the same five stages with clear owners, deadlines, and a written audit trail visible to the client.
Privacy by design
We collect only what is needed to support the appeal. No marketing lists. No data sales. Your file remains your file.
Plain language communication
Written assessments delivered without jargon, upsells, or pressure. The client decides whether and how to proceed.
Built for the U.S. system
Coverage across Medicare Advantage, Medicaid, Marketplace, ERISA employer plans, and commercial insurance in all 50 states.
Your records are safe with us.
We handle Protected Health Information under the same controls trusted by hospitals and large carriers. Encrypted in transit. Encrypted at rest. Logged on every access.
Protected Health Information handled under HIPAA and HITECH operational controls.
All client data encrypted in transit and at rest. No PHI in marketing or logging.
Access, change, and incident controls modeled on SOC 2 Trust Service Criteria.
Coverage across every U.S. jurisdiction including Medicare, Medicaid, and ERISA plans.
Track record performance reviewed and verified Q1 2026 by independent counsel.
No appeal leaves Apellica without sign off from a senior reviewer.
Five stages. Clear owner and deadline on each.
The same proven process on every case, from the letter on your counter to a written decision from your carrier.
Encrypted intake. Acknowledged within one business day. We confirm carrier, plan type, denial category, and the controlling appeal deadline.
A senior reviewer reads the matter within one business day, identifies the denial code, and maps the available appeal levers.
We organize the chronology of treatment, draft the appeal letter, and coordinate any letter of medical necessity from the prescriber.
Filed with the client signature attached. Peer to peer reviews scheduled where applicable. Every carrier request answered the moment it lands.
Status updates every five business days by the channel of the client choice. The matter remains open until a written determination is issued.
Every denial type. Every major carrier.
We work every kind of denial against every major U.S. carrier. KFF marketplace data shows roughly half of appealed denials are overturned, the appeal step is the leverage most patients never use.
The strategy behind a reversal.
Six common denial patterns and the legal or clinical lever we use against each. Illustrative, your actual appeal turns on the facts of your case.
Why people choose Apellica.
What an insurance appeal really costs, who does the work, and what you get with each path.
Comparison reflects typical engagement structures across the U.S. Specific firms, fees, and outcomes vary. Apellica is not a law firm.
What your appeal could look like.
Examples of the appeal levers that typically work for common denial types. Every case is different. Outcomes depend on your policy, your deadline, your records, and your carrier.
Carrier denies a GLP 1 (Wegovy or Zepbound) citing the plan does not cover weight management medications.
- Disclosure: demand the specific clinical criteria in writing under 45 CFR § 147.136
- Pathway pivot: when comorbidities exist (T2D, prediabetes, cardiovascular risk) the prescription path may shift to a covered indication
- Letter of medical necessity from the prescriber documenting comorbidities and prior trials
Plan denies MRI prior authorization citing insufficient documentation of conservative therapy.
- Documentation: assemble PT records, medication trials, and ordering physician notes into one packet
- Clinical evidence: cite the ACR Appropriateness Criteria for the specific clinical scenario
- Urgency: when the ordering physician signs off, the carrier response window can collapse to 72 hours
Carrier denies residential treatment citing lower level of care is sufficient criteria.
- Mental Health Parity (MHPAEA): demand the carrier NQTL comparative analysis under 29 CFR § 2590.712
- Clinical evidence: cite APA, ASAM, and AACAP standards of care
- State DOI parallel filing: California, New York, Massachusetts, and Illinois enforce parity strongly
Plan denies bariatric surgery citing supervised weight management program criteria not met.
- Documentation: assemble all monthly visits, dietitian consults, and psychological clearance into one packet
- Clinical evidence: cite ASMBS guidelines plus comorbidity profile (T2D, sleep apnea, HTN)
- External review: California IMR is binding on the carrier and reverses bariatric matters at high rates
Medicare or Medicare Advantage denies a hospital bed or oxygen citing missing home evaluation packet.
- Documentation: refile with the home evaluation packet (the most common missing piece)
- Clinical evidence: cite CMS Pub 100 02 chapter 15 plus the relevant LCD by ID and effective date
- Escalation: in Medicare Advantage, reach the Maximus IRE which reverses substantially more than plan level reconsideration
Patient receives a balance bill for emergency room services from an out of network provider.
- No Surprises Act: cite 45 CFR § 149.110. Emergency services protections apply. No consent waiver allowed.
- Federal IDR: Independent Dispute Resolution within the statutory window
- State law: many states (NY, CA, NJ) layer stronger out of network protections on top
Apellica is not a law firm and does not provide legal or medical advice. We help organize, prepare, and submit stronger appeals. Outcomes depend on policy language, deadlines, documentation, and carrier rules. See our security and HIPAA program and terms.
Start Your AppealFree to start. You only pay if we win.
No deposit. No hourly billing. No card at intake. A senior reviewer takes your file, prepares a real appeal, and files it. If the carrier reverses the denial and money comes back to you, we keep 10%. If we lose, you owe nothing. That is the deal.
Win-only Appeal Service
A senior reviewer reads your denial, organizes your records, drafts the appeal, cites the controlling regulation, and files it across the carrier's accepted channels. You approve every word before anything is sent. We charge nothing until the carrier reverses the denial and the money is in your hands.
- Free to start. No credit card at intake
- Senior human reviewer on every file. Not a chatbot
- We draft, you approve, we file across mail, fax, and portal
- 10% on the recovery only when the carrier reverses or pays
- If we lose, you owe nothing. No deposit to refund. No bill to argue
Win means a carrier reversal in writing or payment of the disputed amount. Partial reversals are billed proportionally. Full terms on the pricing page.
Concierge Engagement
Premium coordination for complex denials, multi-stage appeals, external review (IRO) escalation, and matters that need ongoing documentation work over weeks or months. Direct point of contact and full strategic oversight from start to finish.
- Priority handling and a dedicated point of contact
- Strategic oversight across multiple appeal stages
- Complex documentation and clinical-record support
- External review and IDR coordination when needed
- Weekly status reporting and outcome tracking
Initial scoping conversation is complimentary. Engagement terms confirmed in writing before any work begins.
Apellica provides appeal preparation, workflow coordination, and documentation organization. We are not a law firm. We do not provide legal or medical advice. We do not guarantee any specific outcome.
Read first. Decide later.
Apellica reads your denial letter and writes a clear summary, free of jargon, before you commit to anything. A senior reviewer looks at every file. Then you decide what to do next.
- Read your summary first. No card required to begin.
- A senior reviewer reads every file. Not a chatbot, not a contractor.
- Clear explanations. No insurance jargon, no legal jargon.
- Cancel any time. No hidden charges. No fine print.
In 2019 my family hit a wall with a carrier denial. I wrote three appeal letters before someone at the insurer finally read the chart their own nurse had already reviewed. Six weeks of stress for an outcome that should have taken twenty minutes of attention.
That's why Apellica exists. Senior reviewers. Charts read twice. Appeals that meet the carrier's own criteria line by line. A clear summary before you commit. No retainers. No upfront fees. No fine print.
Aman YounisFounder & Chief Executive Officer
The questions everyone asks first.
Three ways to begin.
Start my appeal online, talk to a specialist by phone, or visit our offices in Midtown Manhattan. Same senior reviewers either way.
Start my appeal online
Free initial review. Most cases receive a written reply the same business day.
Send the denial. We'll take it from here.
$0 to start. Ten percent only if we win. No card at intake. A senior reviewer reads your denial letter within 24 hours, then we prepare the appeal, file it with the carrier, and chase the decision. One fee, ten percent of whatever the carrier pays you, and nothing if we do not recover.