I'm a nurse. I read the denial letter, I read the chart, and I write the appeal — the one that quotes the insurer's own coverage policy back to them and shows, line by line and page by page, where their criteria are met.
Most people lose the appeal by missing the window, not by losing the argument. Put the date from your letter in and find out.
These are the usual filing windows by plan type. Your letter states your actual deadline and it governs — this is here so you know roughly what kind of time you're working with tonight.
I pull the insurer's published medical policy for the denied service, map your records to every criterion with page citations, and deliver a signed first-level appeal with the enclosure list — within 48 hours of getting complete records. You send it, or I do.
Need it faster? 24-hour turnaround is $150 more. Second-level appeals are $550 flat. External reviews are quoted once we see the first decision.
The denial letter, all pages — photos from your phone are completely fine — and the last visit note or discharge summary if you can find it. If the upload gives you trouble, email them to me instead.
Within one business day. No charge and no obligation, and if I don't think it's winnable I'll say so and tell you what I'd do instead. I would rather lose the fee than take your money for a letter that goes nowhere.
48 hours, flat fee agreed before I start. You'll get the appeal, the enclosure list, and instructions for submitting it — or I submit it for you.
If it's overturned, I'll tell you what to check on the corrected claim. If it's upheld, I'll tell you honestly whether a second-level appeal or an external review is worth it.
Or call 833-990-1622 if you'd rather just talk it through. That's free too.
Registered nurse, licensed in Texas. I know how the system works from the inside: what a reviewer looks at, what they're required to consider, and what a chart has to say before they can approve it.
A plain-English care review of the records, and ongoing help coordinating specialists, facilities and the insurer when it isn't one problem.
Documentation audits against payer coverage criteria for practices and agencies — and a referral relationship for attorneys, social workers and care managers.