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The free tool below runs entirely in this browser — no account, nothing stored or transmitted. Redact anything you would not want kept before you type it.
Open the companion tool →Why published metrics are a consumer tool
A plan with a high denial rate and a low appeal-overturn rate is describing how it behaves. That description is more useful than any marketing page.
The metrics also give you a benchmark: if your plan's published average is two days and your request has waited ten, you have something concrete to cite.
The protocol
- Download the plan's published prior-authorisation metrics and note the reporting period.
- Record the standard and urgent decision averages and the denial and appeal outcomes.
- Compare the same figures across the plans available to you.
- Keep the figures with your own case, and cite them if your request runs long.
- Re-check before the next enrolment period, because the numbers move.
What the tool does
Build a payer denial-metrics comparison It runs locally in this browser and sends nothing.
Limit first: This is a preparation aid, not medical, legal or insurance advice. It cannot force a payer to pay, guarantee an appeal outcome, or tell you which care is right for you.
Open the companion tool →Cost and free path
Cost: Free: one complete run in this browser, no account. Optional $4 one-time unlock allows unlimited runs of this tool on this browser. The free path and safety guidance never require payment.
Rule status (mixed route): Status, 2026-10-03: public prior-authorisation metrics reporting began 2026-03-31 for impacted payers; HHS OIG found 13% of Medicare Advantage prior-authorisation and 18% of payment denials met coverage rules, with most appealed prior-auth denials overturned.
Automated decision this documents: payer prior-authorisation denial behaviour
Free path, in order (no cost):
- The plan's own published prior-authorisation metrics page
- SHIP or your state's free insurance counselling service
- Medicare's plan-finder and complaint routes
What this cannot do: It cannot force a payer to pay, guarantee an appeal outcome, or tell you which care is right for you.
Sources checked 2026-10-03 · source bank reviewed against the live pages listed in metadata.
One human next step
Bring the comparison to an enrolment counselling session, or use it in an appeal: cite the plan's own published turnaround next to your request's dates.
Research log and safety checks
AI-assist path: not used for a verdict. This builder organises the reader's own documents and names an independent source; it does not infer authenticity, eligibility, or legal rights. §6.9/§6.10/§6.11 disclosed in the batch report; §6.12 status line carried in metadata as `status_line`.
§0.5 protection result: category is insurance-and-medical-costs; crisis-adjacent: no; fear/urgency/scarcity toolkit used: no. The protective function is free and the paid feature is convenience only.