The Evidence
Do insurance appeals actually work?
Yes. About half of patients who appeal a denial win. The data proves that when patients fight back with evidence, they win.
~50%
Overturn Rate
About half of patients who appeal a denial win — and Medicare Advantage plans overturned 75% of appealed denials.
Public Case Files & Investigations
How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them
Source: ProPublica
An investigation revealed how insurers use automated systems to instantly deny large volumes of claims, proving that initial denials are often not based on medical necessity but on algorithmic thresholds.
Impact: Exposed automated denial engines
OIG Report: Medicare Advantage Organizations Denied Millions of Requests
Source: Department of Health & Human Services
A federal investigation found that 13% of prior authorization denials by Medicare Advantage plans were for services that met Medicare coverage rules. The report highlighted systemic flaws in the denial process.
Impact: Confirmed systemic improper denials
When Insurance Denies Care, Patients Fight Back—And Often Win
Source: KFF Health News
Data shows that while the appeals process is arduous and complex, patients who persist and provide clinical evidence have a surprisingly high success rate in overturning initial denials.
Impact: Patients often win on appeal
A simple algorithm shouldn't decide your healthcare
Source: NPR
Exposes on predictive algorithms used by insurers to cut off care prematurely, particularly in rehab and extended care settings, leading to lawsuits and regulatory scrutiny.
Impact: Triggered class-action lawsuits
The Precedent is Set.
It's time to claim what you're owed.