When the plan says no, give the patient somewhere to go
Medical oncology and radiation oncology practices, where denials for off-label chemotherapy, genomic testing and proton therapy delay time-critical care. 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
- Chemotherapy or immunotherapy off-label for the indication
- Genetic and genomic testing not medically necessary
- Proton beam therapy experimental
- PET surveillance imaging
- Supportive drugs (antiemetics, growth factors) quantity limits
The sentence at the desk
“The plan denied part of your treatment plan. Scan this before the next visit: a free read tells you whether it can be appealed and how fast.”
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 compendium or guideline citation the oncologist relies on (nccn category, fda label, peer-reviewed evidence). 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 compendium or guideline citation the oncologist relies on (NCCN category, FDA label, peer-reviewed evidence)
- 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
- Cancer diagnoses in California independent review →
- Genetic and genomic testing decisions →
- Experimental or investigational 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 oncology practices is onc-. Paste the link into the denial message you already send patients, or put the QR card at the desk.
https://apellica.com/start?ref=onc-yourname&utm_source=partner&utm_medium=referral&utm_campaign=onc-yourname
Questions oncology practices ask
Our patients need expedited appeals.
Urgent appeals must be decided within 72 hours under the federal rules that govern most plans. The reviewer flags urgency on the first read and the appeal is prepared for the expedited track.
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.