Getting your denied claims out of your insurer
You do not need our permission or a special integration to see why you were denied. The plan has to tell you, in writing, and it has to hand over the records and criteria the decision was based on. Most people never ask, which is exactly why denials stick.
Start with the letter you already have
This works with every insurer today. Photograph the denial and we read it on your device, tell you what the reason means, and show you the deadline it starts. Nothing is uploaded to do that.
What your plan owes you, and how to ask
Two separate rights, often confused. Both are worth using.
The claim file and the criteria
If your plan is an employer plan governed by ERISA, you can demand the documents the decision rested on: the internal clinical criteria applied, the reviewer's qualifications, and everything in the claim file. Plans frequently fail to produce it, and that failure is itself an argument on appeal. We have a letter that asks for it correctly.
Free claim-file request letter →Your claims data, on request
Under the CMS interoperability rules, Medicare Advantage, Medicaid and marketplace plans must make your claims and coverage information available to you through an application you choose. That is a right you hold, not a service we perform. Your insurer's member portal is usually the fastest route to the claim numbers and dates you will need.
Which rules apply to you
Whether your appeal runs on federal ERISA rules, your state's rules, or the Medicare ladder depends on how your plan is funded. It changes your deadline and where an external review goes.
Look up how your employer's plan is funded →Automatic claim retrieval is not live yet
We are building a way to pull your denied claims straight from your insurer, so you do not have to find them yourself. It is not working yet, and we would rather say so than imply otherwise. Tell us who insures you and we will let you know when yours is ready.
Would rather just talk to someone?
A specialist can tell you what to ask your insurer for and in what order. Monday to Friday, 8 AM to 7 PM Eastern; Saturday, 10 AM to 4 PM.
Call +1 (888) 777-6120Apellica is an administrative appeal-preparation service, not a law firm, and this page is general information rather than legal advice.