What Apellica cannot help with.
We would rather be honest up front than waste your time. Here are the situations where we are not the right resource. and where to go instead.
Medical advice or clinical decisions
We do not diagnose, prescribe, or recommend treatments. Talk to your treating clinician for medical decisions. We work alongside your clinician to make the case for coverage that they have already recommended.
Legal advice or representation in court
We are not a law firm and do not provide legal advice. We help with internal and external administrative appeals. If your matter requires litigation, we will refer you to a licensed healthcare attorney.
Cases past the appeal window with no urgent-care exception
Most appeal windows are 180 days from denial; some are shorter (Medicare Part D is 60 days, expedited tracks even tighter). If the deadline has passed and no urgent or continuity-of-care exception applies, we cannot file a timely appeal.
Provider billing disputes that are not insurance denials
If your provider's office made a billing error and the carrier never received a claim, the right path is to call the provider's billing department, not file an appeal.
Workers' compensation, auto insurance, disability insurance
We focus on health-insurance claim denials. Workers' comp, auto, and short-/long-term disability appeals follow different procedures and we are not the right resource. We can refer you.
Social Security disability appeals
SSDI/SSI appeals follow the federal Social Security administrative process. There are excellent specialty firms for this. We are not one of them.
Cases where there is no appealable denial
If your claim was paid correctly per your plan benefits, there is no denial to appeal. We will tell you this honestly and not start work on a case that does not exist.
Predicting outcomes
Outcomes depend on policy language, deadlines, documentation, the specific carrier's rules, and the strength of the medical record. We do not guarantee any specific outcome on any case. We give honest reads, not promises.
Not sure if your case fits?
Send it through anyway. If we are not the right resource, we will tell you, and we will point you to who is.
- Apellica is not a law firm and does not provide legal advice. Apellica does not provide medical advice. Apellica is not an insurer or a health-care provider.
- We help patients organize, prepare, and submit stronger health insurance appeals. We do not guarantee approval or any specific outcome on any case. Outcomes depend on policy language, deadlines, documentation, and the carrier's rules.
- You remain responsible for tracking your appeal deadlines unless and until Apellica formally accepts your case in writing. For urgent medical decisions, consult a licensed provider.
- Information you submit may include Protected Health Information (PHI). We treat it under our security & HIPAA program and privacy policy.