When the plan says no, give the patient somewhere to go
Outpatient MRI, CT and PET centers, where a prior-authorization denial arrives after the scan has already been scheduled. 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
- MRI and CT not medically necessary (conservative-therapy criteria not documented)
- PET scan experimental for the indication
- Advanced imaging denied by a radiology benefit manager (eviCore, Carelon, HealthHelp)
- Site-of-care denials steering to a hospital outpatient department
The sentence at the desk
“Your plan denied the scan. Before you cancel, scan this code: an independent service reads the denial for free and tells you whether it can be appealed.”
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 ordering clinician's notes documenting the conservative therapy and red-flag findings. 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 ordering clinician's notes documenting the conservative therapy and red-flag findings
- 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
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 imaging centers is img-. Paste the link into the denial message you already send patients, or put the QR card at the desk.
https://apellica.com/start?ref=img-yourname&utm_source=partner&utm_medium=referral&utm_campaign=img-yourname
Questions imaging centers ask
Does this slow down our schedule?
No. The patient keeps their slot or reschedules as usual. The appeal runs on the patient's side; if the denial is reversed, the authorization arrives the same way it always does.
Can we send the denial ourselves?
The patient must authorize Apellica directly. Give them the card or link; they upload the letter themselves.
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.