Frequently Asked Questions

We are a nonprofit that helps patients reverse wrongful health insurance denials at no cost. We work with you to build strong, documented appeals and stay with you every step of the way: from initial review through regulatory escalation when necessary.

Yes. Our denial support is a zero-cost public service for patients. We are a 501(c)(3) nonprofit and do not charge patients for our services.

Our work is made possible through generous philanthropic grants and individual donations.

Our support is focused specifically on appealing wrongful health insurance coverage denials. We help people with both prior authorization denials and post-service denials, and we help people who are covered by all types of comprehensive health insurance, including employer sponsored private insurance, private insurance from ACA exchanges, Medicaid, Medicare, Tricare, CHIP, and GEHA plans. We are currently helping people in all medical contexts with all types of coverage denials. However, we focus on reaching those facing denials that have historically caused disproportionate harm, based on data and reports. Depending on capacity, we may need to limit the types of situations we can support. If this happens, we will temporarily restrict attention to our outreach focus areas until our capacity allows for more general support. Please refer to our intake platform to see where we currently focus.

While people face many issues related to health insurance coverage, our support is focused specifically on appealing wrongful health insurance coverage denials. We generally cannot help with: 1) enrolling in health insurance; 2) provider billing disputes that are unrelated to insurance coverage issues; 3) coverage denials that are clearly consistent with a governing plan (if it's unclear whether or not that is the case, we can help make that determination); 4) coverage denials that have already been unsuccessfully appealed through all levels of available appeal (if it's unclear whether or not that is the case, we can help make that determination); 5) coverage denials for which the appeals process has lapsed (if it's unclear, we can help make that determination); and 6) requests to publicly share a story or get media attention on a situation. Whenever possible, we try to suggest options and be helpful to those who reach out about these issues, but don't always have capacity.

No. We do not offer legal services, legal advice, medical services, or medical advice. We build individualized appeals and stay with clients from initial review through every available level of recourse, including regulatory escalation when appropriate.

We start by reviewing your denial situation and the documentation you have. We then assess how we can best help and build a comprehensive appeal on your behalf. We use our knowledge of insurance regulations, medical records analysis, and our specialized software to construct the strongest possible case.

Not always. We assess appeal, complaint, and regulatory options that may be available based on all we've learned about the situation, present options, and recommend a path forward. An appeal isn't always the fastest or best path, nor is one always available.

Click any of the 'Get Help' buttons on this site to be directed to our intake platform. Share your denial situation, and we will review what you are dealing with and let you know what we will need to help you.

Appeals are effective, but underused: less than 1% of denials are ever appealed, yet 30% to 50% of appeals succeed on average, and appeals prepared by experts do even better. Our historical success rate is 96%.

You may! Most health insurance plans afford people multiple levels of appeal. And the higher levels tend to be more fair, and less biased, because they are reviewed by independent third parties. We can help you determine what options you may have.

Yes, we develop machine learning (ML) tools to assist experts. Tools we develop help us analyze regulations, medical literature, and clinical policies more efficiently, but people work on every case, make all decisions, and still do most of the heavy lifting. Your personally identifiable information never gets input into third-party AI systems. Our team has real ML expertise, and we are also deeply critical of a large majority of most current uses of AI. We use ML in narrow, specific ways we've verified actually help, and we know how harmful misuse can be. Most of the AI/ML we use is not generative. We are vehement critics of those who promote AI-slop, which is harmful.

No. Appeal letters that we draft are a key part of our work, but far from the only part. Other ways our intervention proves useful include: 1) helping patients identify appropriate appeal recourse 2) acquiring documentation from health plans 3) tracking documents and deadlines 4) enlisting regulatory support when health plans fail to comply with rules 5) helping to mitigate the stress and anxiety that comes from being left to challenge wrongful denials alone, and while ill.

Each letter we prepare is individualized and constructed with care based on the particular context of our client’s case. The letters are not generated from a template or template engine, since medical situations and history, and coverage rules, vary considerably, and such templates often fail to capture the merits of individual coverage requests. Our drafts do not typically resemble the brief, generic letter templates that are commonly distributed online. For us, drafting a letter typically involves assessing medical literature, contract provisions, applicable law, and medical records as they relate to the denial and individual affected. This has allowed us to maintain a very high appeal success rate.

No. Just as we don’t use templates, our letters are not the result of prompting language models for a letter. We know that constructing letters in this way is irresponsible and ineffective. Coverage denials can have life and death implications, and language models do a poor job of surfacing authoritative information in ways that caseworkers can efficiently verify. We do use language models, but only in very limited scope ways. We never use them for end to end generation, and we never input identifying information into third party systems. Most of the ML/AI we use is not generative.

Yes. Even if you know how to write an appeal, extra expert review can be helpful. Just as importantly, with permission your case can add to a shared record we use to make egregious denial patterns visible and drive systemic change. This is leverage that's much harder to build alone.

Yes, it's relevant. As a nonprofit, we have less incentive to prioritize speed or volume over quality. Low-quality, rushed appeals can and do fail. We know that the stakes can be life and death for the patients we serve, and we approach our work accordingly. We are a nonprofit because we are accountable to people and prioritize equity and access, not shareholders.