When the plan says no, give the patient somewhere to go

The denials you see

• Residential or intensive outpatient level of care not medically necessary
• Session limits and frequency
• ABA therapy hours
• Out-of-network care where no in-network clinician is available
• Prior authorization for continued treatment

The sentence at the desk

“The plan denied continued treatment. Scan this: mental health parity and level-of-care rules give you more appeal rights than the letter suggests.”

That is the whole workflow. The card carries a QR code with your referral code, the patient scans it while the denial is in their hand, and every start is attributed to your office.

What happens next

1. 1The patient uploads the denial letter (photos are read on their device; only the text is sent). A reviewer answers in writing, usually the same business day: appealable or not, which rule, what deadline.
2. 2If it can be won, Apellica prepares the internal appeal with the criteria demand, the record mapped to each criterion, and primary-source citations, then the external-review request if the plan holds.
3. 3Your office is asked once for what only it can supply: the treatment plan, level-of-care assessment and progress notes. The plan's criteria come with the request so the letter is written in one pass.
4. 4The patient pays nothing upfront. If the appeal recovers coverage or money, the fee is 10% of the recovery; if not, nothing. Apellica is not a law firm and says so when a matter needs one.

What we will ask your office for

• The treatment plan, level-of-care assessment and progress notes
• The denial letter the patient received (the patient uploads it; you need do nothing)
• A letter of medical necessity written to the plan's criteria, once, when the appeal is being prepared; we send the criteria with the request
• Nothing else: no contract, no fee, no data feed

The numbers your patients should know

• Mental-health decisions in California independent review →
• Mental health parity lever →
• Level of care denial guide →

Fewer than 1% of denied claims are appealed (KFF, 2024 HealthCare.gov filings). In California, independent reviewers sided with the patient in 52.5% of 42,710 decisions, and 72% in 2025 (DMHC). All research →

Your referral link

Codes use letters, digits and dashes; the suggested prefix for behavioral health practices is bh-. Paste the link into the denial message you already send patients, or put the QR card at the desk.

https://apellica.com/start?ref=bh-yourname&utm_source=partner&utm_medium=referral&utm_campaign=bh-yourname

Questions behavioral health practices ask

Other settings

• Imaging centers
• Specialty and infusion pharmacies
• Oncology practices
• Infusion centers
• Surgical practices
• Physical and occupational therapy
• Hospitals and case management
• Billing departments and RCM teams
• Prior-authorization teams
• Clinics and pharmacies