When the plan says no, give the patient somewhere to go
Ambulatory infusion centers delivering biologics, IVIG and iron, where site-of-care and medical-necessity denials arrive between doses. 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
- IVIG not medically necessary or experimental for the diagnosis
- Biologic infusion step therapy
- Site-of-care redirection to home infusion
- Dosing outside the plan's policy
- Continuation denied after initial approval
The sentence at the desk
“The plan denied your next infusion. Scan this today: ongoing treatment usually qualifies for a 72-hour expedited appeal.”
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 treating specialist's note on prior therapies, measurable response and dosing rationale. 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 treating specialist's note on prior therapies, measurable response and dosing rationale
- 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
- IVIG decisions in California independent review →
- IVIG appeal guide →
- Biologic infusion appeal 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 infusion centers is inf-. Paste the link into the denial message you already send patients, or put the QR card at the desk.
https://apellica.com/start?ref=inf-yourname&utm_source=partner&utm_medium=referral&utm_campaign=inf-yourname
Questions infusion centers ask
What about the dose that is due this week?
Continuation-of-care rules and the urgent-appeal clock exist for exactly this. The reviewer reads the letter the same day and tells the patient whether the expedited track applies.
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.