Healthcare problem resolution
A denial is an opening
position. Answer it properly.
Resolve expensive medical bills before they cost you more money. The Denial Appeal Builder turns your denial notice into a finished, regulation-cited appeal letter — with every deadline tracked for you.
No account needed. Nothing shared with your insurer by us.
180 days
to appeal most employer and marketplace denials
29 C.F.R. § 2560.503-1(h)(3)(i)
65 days
to file a Medicare Advantage reconsideration
42 C.F.R. § 422.582(b)
$0
balance billing allowed for protected emergency care
45 C.F.R. § 149.110
Understand the bill. Find what is wrong. Take the action that fixes it.
Name the denial
Insurer, the reason code on your Explanation of Benefits, and whether your plan is self-funded, fully insured, marketplace, Medicare Advantage or Medicaid managed care.
We cite the law that binds them
ERISA claims-procedure rules, the No Surprises Act, Medicare Advantage reconsideration rules, parity and formulary-exception rules, and your state's external review route.
Get the letter, not a template
A finished PDF with your dates, your claim number, the arguments that fit your denial category, a records demand, and an evidence checklist — ready to mail or fax today.
Never miss the clock
Your appeal and external review deadlines are calculated from your denial date, and we email you 14 days, 7 days and 1 day before each one.
Denial reasons covered
- Not medically necessaryCO-50
- No prior authorization on fileCO-197
- Experimental / investigationalCO-55
- Surprise bill — emergency or out-of-network at in-network facilityCO-B7
- Out of network (non-emergency)CO-242
- Service excluded / not a covered benefitCO-96
- Filed too late / untimelyCO-29
- Coding, bundling, or downcodingCO-97
- Not eligible / no coverage on date of serviceCO-27
- Step therapy / formulary exception deniedCO-50
Plan types and their clocks
- Employer plan — self-funded180 days
- Employer plan — fully insured180 days
- Marketplace / ACA exchange plan180 days
- Individual / off-exchange state plan180 days
- Medicare Advantage (Part C)65 days
- Medicaid managed care60 days
Each plan type also routes to a different second level — federal external review, a state Department of Insurance program, a CMS Independent Review Entity, or a state Medicaid fair hearing. The builder names yours.
The insurer wrote you a form letter. Write back with citations.
Ten minutes of answers produces a letter that names the regulation, demands the claim file, and starts a paper trail your plan has to answer.
Start my appeal