How we research, write, and review
Insurance appeals sit at the intersection of health, money, and law. We treat the topic with the rigor that intersection demands.
Sourcing
Every claim of law, regulation, or carrier procedure on Apellica is sourced to a primary authority, the eCFR for federal regulations, CMS for Medicare/Medicaid policy, DOL EBSA for ERISA-governed plans, state insurance departments for state-specific procedures, and the Kaiser Family Foundation for denial-rate statistics. We do not cite third-party summaries when the primary source is available.
Review cadence
Every pillar guide and resource page on apellica.com displays a "Last reviewed" date in its header. We re-review each guide at least quarterly and after any material change in federal regulation, CMS guidance, or major-carrier policy. The review checks: (a) all federal CFR citations remain current; (b) all cited statistics remain the most recent published; (c) any carrier-specific procedure or deadline has not changed; (d) any broken external link is repaired.
Who reviews
Content is researched and drafted by Apellica's editorial team , health policy researchers and former benefits navigators with hands-on experience in 1,200+ insurance appeals. Where we make claims about clinical practice (medical necessity criteria, treatment indications, comorbidity guidelines), we cite the relevant professional society position statements directly rather than inferring from secondary sources.
Apellica is not a law firm and does not provide legal advice. We do not employ practicing physicians for individual clinical-judgment review of patient cases. Where guidance involves clinical decisions specific to a patient, we explicitly note that the patient's treating physician is the appropriate authority.
Conflict of interest
Apellica is a paid service for the preparation of evidence-based appeal documents. Our content explicitly lists free alternatives (state Consumer Assistance Programs, DOL EBSA Benefits Advisor, nonprofit patient-advocacy foundations, the NIH-grant-funded Counterforce Health) so prospective customers can make an informed choice. We do not accept fees, advertising, or sponsored placements from health insurance carriers, pharmacy benefit managers, or pharmaceutical manufacturers.
Statistics policy
Every statistic we publish names its population, its year and its source, because the same number rarely applies to every plan. Two we use often: insurers in HealthCare.gov plans upheld 56% of appealed denials in 2023 and overturned the other 44% (KFF, published January 2025), and Medicare Advantage insurers overturned 80.7% of appealed prior-authorization denials in 2024, out of the 11.5% of denials that were appealed at all (KFF, published January 2026). The second figure is Medicare Advantage only; CMS publishes no commercial equivalent, so we never present it as a general appeal success rate. We do not present Apellica-internal pilot data as industry-wide. Where we reference Apellica caseload outcomes, we label them as such and note the sample size when available.
Plain-language commitment
Insurance appeals involve dense regulation. Where regulation is quoted directly (CFR sections, statutory text), we follow with a plain-language paraphrase so the meaning is accessible. We avoid jargon when ordinary words suffice and explicitly define industry terms on first use (or link to our glossary).
Corrections
If you spot an error of fact, citation, or interpretation, email editorial@apellica.com. We correct material errors as quickly as we can verify them, and we update the "Last reviewed" date when we do.