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

Orthopedic, spine, bariatric, plastic-reconstructive and general surgery practices, where a pre-service denial cancels a booked case. 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.

Print desk cards Print the front-desk sign Get a referral code

The denials you see

Not medically necessary: conservative therapy not documented
Bariatric surgery criteria (BMI history, supervised program)
Spinal fusion and disc replacement
Breast reconstruction and reduction
Out-of-network surgeon or facility

The sentence at the desk

“Your surgery was denied. Scan this before you cancel: an independent read shows whether the denial can be appealed and what the office needs to send.”

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 pre-operative notes, imaging report and the record of conservative treatment. 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 pre-operative notes, imaging report and the record of conservative treatment
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 surgical practices is surg-. Paste the link into the denial message you already send patients, or put the QR card at the desk.

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

Desk cards (10 per sheet) →Patient handout →Front-desk sign →Embed the decoder on your site →

Questions surgical practices ask

Peer-to-peer already failed.

A failed peer-to-peer is the start of the written record, not the end. The written appeal maps the record to each criterion the plan cites and, if the plan holds, goes to an independent reviewer who is not the plan's medical director.

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.