Printable referral materials
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A denial is a first answer, not the final word.
1. Keep the letter. The reason it gives decides what the appeal has to prove, and the deadline printed on it controls. Most employer and Marketplace plans give at least 180 days; Medicare Advantage 65 days from the notice; Medicaid managed care 60 days.
2. Ask the plan for its file and the criteria it used. You are entitled to both, free of charge. The criteria become the checklist the appeal answers.
3. Get a free read before you decide anything. Scan the code. Upload or photograph the letter. A reviewer at Apellica answers in writing, usually the same business day: whether it can be appealed, under which rule, by when.
4. If it can be won, Apellica prepares and files the appeal with the plan's criteria answered point by point and the rules cited. Nothing upfront and no card. If the appeal recovers coverage or money, the fee is 10% of the recovery. If not, nothing.
5. Your clinic is asked once for the medical-necessity letter and the notes the plan's criteria call for. We send the criteria with the request.
Fewer than 1 in 100 denied claims is appealed (KFF, 2024 HealthCare.gov filings). Independent reviewers in California sided with the patient in 52.5% of 42,710 decisions, and 72% in 2025 (DMHC). Free routes also exist: your state's Consumer Assistance Program for insured plans, the U.S. Department of Labor for self-funded employer plans, SHIP for Medicare.