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.
For when you have a stack of records and no idea what any of it means. You get back a written report: what's actually going on in plain English, the medications with safety flags, the gaps and loose ends nobody mentioned, and a numbered list of questions to hand the doctor at the next appointment.
Covers up to 75 pages. Beyond that it's $1.50 a page, and I'll tell you the number before I start.
Coordinating between specialists, facilities, discharge planners and the insurance company, when it's more than one problem and it isn't stopping. One-hour minimum.
Or $625 a month — four hours, two scheduled calls, messages in between. Cancel whenever.
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.
Eleven years at the bedside in Houston — emergency, telemetry, medical-surgical, home health, home infusion, and case management.
Case management is where this work comes from. I spent years on the other side of these decisions: making the calls, sending the documentation, listening to a reviewer say no to something I'd watched a patient need. I know what the reviewer is looking at, what they're required to consider, and what a chart has to say before they can approve it.
Elder-law attorneys, hospice and palliative social workers, oncology navigators, geriatric care managers — you see these families constantly and there's rarely anyone to hand them to. I'll close the loop with you on what happened, with the family's permission.
Practices and agencies: I also do documentation audits — 20 to 30 charts against payer coverage criteria, with a report that leads with the dollars at risk and a fix list ranked by impact. $60 a chart, $900 minimum, ten business days.
Get the one-page referral handout