Operational Protocol
Here's exactly
How we do it.
No magic. No mystery. Just your payer's own words, put together the right way.
The Asymmetry
Most patients never see the rules their insurer is using.
Every major US insurer publishes their clinical coverage criteria. These are the exact policies their reviewers are supposed to use when deciding whether to approve or deny a claim. Aetna's policies run to 400+ pages. United Healthcare's are similar.
Most patients never see these documents. They're public, but they're not easy to find, and they're written for physicians and reviewers, not patients.
We read them for you.
Your Denial
You tell us the basic facts of the denial. If you have the letter, upload it directly and we'll pull out the payer, service, and denial reason.
- Your insurer (Aetna, Cigna, UHC, BCBS, etc.)
- The procedure or service denied
- The exact denial reason or code
- Your raw denial letter (optional)
Our Search
We find the published clinical policy that applies to your denial, then look for the coverage criteria that should have governed the decision.
- Specific coverage criteria for your procedure
- Clinical conditions under which it is covered
- Required documentation to support a claim
- The exact paragraph that should have applied
Your Letter
We write the appeal letter in reviewer-friendly language, with citations specific enough to get a real second look.
- Cites the specific policy section by name and number
- Restates your clinical situation in the policy's language
- Requests reconsideration based on documented criteria
- Provides a draft you can review, edit, sign, and send
What we don't do
We don't give legal advice. We don't practice medicine. We don't make promises about outcomes.
What we do: give you the language and structure of an appeal that cites real documentation, which is the difference between an appeal that gets a second look and one that gets auto-rejected.