Appeals capacity for patient support programs and benefits navigators
Your members send you the denial. We turn it into a cited appeal, with the deadline, the plan-type-correct rules and the evidence list, and hand it back for your team to review and send.
What you get
A decoded denial (reason, plan type, deadline with the statute), a letter built on the lever that fits the denial, a records request the plan must answer, and reminders until the decision. Every citation is verified before it leaves; nothing is sent without a human on your side approving it.
Why the data matters
Insurer denial rates and appeal-overturn rates by state and issuer from the CMS transparency files, and California external-review outcomes by treatment: weight-control denials, for example, were overturned in 1,365 of 1,581 decisions (86.3 percent, 2003 to 2026). Your case managers cite the numbers; your members stop guessing. Insurer denial rates · weight-control outcomes.
How it fits
Flat per-appeal pricing for organizations, white-label letters, an API, and an embeddable decoder and deadline calculator (see the embed kit). BAA on request. No percentage-of-recovery arrangements with organizations.
Tell us your program and monthly denial volume
We reply within one business day. Apellica, Inc. prepares and files insurance appeals; it is not a law firm and does not pay or receive referral fees.