When the plan says no, give the patient somewhere to go
Case managers, discharge planners and patient financial services, where inpatient, post-acute and observation denials land on the patient at discharge. Apellica reads the denial for free, in writing, and prepares and files the appeal if it can be won. Nothing upfront for the patient; nothing paid or received by your office.
The denials you see
- Inpatient admission downgraded to observation
- Skilled nursing or inpatient rehab placement denied
- Notice of Medicare Non-Coverage on discharge
- Emergency visit denied as non-emergency
- Out-of-network facility balance bills
The sentence at the desk
“The plan denied the next step in your care. Before discharge, scan this: some of these appeals have deadlines measured in hours.”
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
- 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.
- 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.
- 3Your office is asked once for what only it can supply: the discharge summary and the case manager's placement request. The plan's criteria come with the request so the letter is written in one pass.
- 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 discharge summary and the case manager's placement request
- 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
- Skilled nursing facility denials (fast-track rules) →
- Inpatient hospital stay denials →
- Emergency care: the prudent-layperson rule →
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 hospitals and case management is hosp-. Paste the link into the denial message you already send patients, or put the QR card at the desk.
https://apellica.com/start?ref=hosp-yourname&utm_source=partner&utm_medium=referral&utm_campaign=hosp-yourname
Questions hospitals and case management ask
Does this conflict with the hospital's own appeal?
No. The hospital appeals the payment; the patient appeals coverage. Both can run, and the patient's expedited QIO or plan appeal often resolves first.
Is there any fee or revenue share?
No. Apellica does not pay or accept referral fees. Anti-kickback and state fee-splitting rules make that a risk for both sides; it is a link, nothing more.