Your patient was denied. Give them somewhere to go.
A denied prior authorization ends most treatments because nobody has the hours to appeal it. Apellica prepares and files the appeal for your patient, in their name, at $0 upfront. You give them a link. No fee is paid or received in either direction.
Who this is for
GLP-1 and weight-management clinics
Wegovy, Zepbound, Mounjaro and Ozempic prior-authorization denials, plan exclusions, BMI-criteria and step-therapy refusals. The patient keeps the clinician's drug instead of dropping to cash pay or a compounded alternative.
Specialty and compounding pharmacies
Formulary exclusions, non-formulary tiers, quantity limits and fail-first requirements on biologics, migraine and specialty drugs. A denied fill is a lost fill; an appealed one often comes back.
Infusion centres and buy-and-bill practices
IVIG, biologic and other infusion denials on medical-necessity or site-of-care grounds, where the record usually already supports the service.
Prior-authorization staff in specialty practices
Rheumatology, gastroenterology, neurology, endocrinology, allergy and nephrology offices that run out of hours before they run out of denials.
What happens after the click
- Step 1
The patient clicks your link
It lands on Apellica's start page with your referral code attached, so you can see later how many of your patients used it. No account, no card.
- Step 2
A reviewer reads the denial
The patient uploads the denial letter. A senior reviewer reads it within 24 hours and tells them in writing whether it can be appealed and how.
- Step 3
Apellica prepares the appeal
Written against the plan's own criteria and the patient's record, with citations. The patient reads and approves every word.
- Step 4
It is filed in the patient's name
Apellica tracks the deadline. Your office is asked only for what an appeal genuinely needs: usually a letter of medical necessity and the relevant notes, requested once, with the patient's authorization.
The link kit
Prefer a tool on your own site? Embed the decoder, the deadline calculator or a report-card badge; one line of HTML, attributed, no tracking of your visitors.
You can start today without talking to us. Replace YOURCLINIC with a short name for your organisation (letters, digits, dashes) and use the link anywhere a denied patient sees it: the denial email, the portal message, the after-visit summary, the front-desk script.
https://apellica.com/start?ref=YOURCLINIC&utm_source=partner&utm_medium=referral&utm_campaign=YOURCLINIC
Your plan has denied coverage for the medication we prescribed. You have the right to appeal, and most people never do. If you would like help, Apellica prepares and files appeals for patients at $0 upfront and charges 10% of what is recovered only if the appeal succeeds. Start here: [your link]. Our office will provide the medical records and letter the appeal needs.
“The plan denied it. You can appeal, and there is a service we can point you to that prepares the appeal for you with nothing to pay upfront. I will send you the link in a message. They will ask us for your records and a letter, and we will send those.”
What we will ask your office for
A letter of medical necessity when asked
Answering the plan's criteria by name. We send the criteria with the request so the letter can be written in one pass.
The relevant notes
Prior treatments tried, results, contraindications: the records the criteria ask for. Released only under the patient's authorization.
A named contact
One person who can answer a question about a file within a business day. Most appeals need one exchange.
What we do not do
- We do not pay referral fees and we do not accept them. Federal Anti-Kickback rules and state fee-splitting laws are strict about patient referrals, and a fee arrangement would put both organisations at risk. The arrangement is a link and a shared interest in the patient staying on the treatment the clinician chose.
- We do not give diagnosis-coding or documentation-coaching advice. What to code is the clinician's decision. We ask for the record as it exists.
- We do not appeal oncology drug denials. Those patients are referred elsewhere for that subset.
- We are not a law firm and do not give legal advice. Where a matter needs a lawyer we say so.
The numbers, with their sources
KFF's analysis of the first insurer-level prior-authorization metrics published under CMS-0057-F, ranging up to 17% (UnitedHealth, MA) and 25% (Centene, ACA).
KFF, Prior Authorization Metrics Provide New Insights into Insurer Practices, August 2026Non-grandfathered plans must give at least 180 days to file an internal appeal and offer independent external review after it (45 CFR 147.136). Most denied patients never use either.
45 CFR 147.136, internal claims and appeals and external reviewQuestions clinics ask
What does the patient pay?
Nothing upfront and no card to start. If the appeal succeeds, Apellica charges 10% of what is recovered; if nothing is recovered, nothing is charged. The terms are the same whether the patient arrives through your link or on their own.
What does my clinic or pharmacy pay, or receive?
Nothing either way. Apellica does not pay referral fees and does not accept them. You give the patient a link; Apellica does the work. If you want your logo on the landing page the link opens, ask and we will set it up at no charge.
How much of my staff's time does an appeal take?
Usually one exchange: a letter of medical necessity written against the criteria we send you, plus the notes the criteria ask for. We do not ask your office to fill in forms or call the plan.
How is protected health information handled?
The patient authorises Apellica directly and uploads their own documents. Anything we request from your office is released under that authorisation, limited to the minimum necessary for the appeal. We do not claim a certification; we describe the process and put it in writing.
Can I see how many of my patients used the link?
Yes. Your referral code is attached to every start that comes through your link. Ask us for the count at any time; we do not share who they are or what was denied.
What happens when the appeal cannot be won?
The reviewer says so in writing at the first read, before any work starts, and tells the patient what else is available: the plan's exception process, the manufacturer's programmes, or external review. Nobody is charged for that answer.
Is Apellica a law firm?
No. Apellica, Inc. prepares and files insurance appeals and related requests. It is not a law firm, does not provide legal advice, and is not a medical provider.
Set up a referral link
Tell us who you are and we will confirm your referral code, send the link kit with your name in it, and answer any question about the process. We reply within one business day. No fee, no contract, no obligation to use it.