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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 the denial reason is the whole appeal
A vague denial cannot be answered. A denial that names a criterion can be met with the treating clinician's documentation for exactly that criterion.
Most people never appeal, yet appeals are frequently successful — the leverage gap is paperwork and deadlines, not merit.
The protocol
- Get the denial in writing and note the date it was issued.
- Request the specific clinical criteria and the evidence standard the plan applied.
- Ask the treating clinician for a short letter addressing those criteria directly.
- File the appeal within the plan's deadline and keep the submission receipt.
- If deadlines are missed by the plan, say so in writing and ask for the denial to be treated as adverse with appeal rights.
What the tool does
Build a prior-authorisation appeal packet 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: the CMS interoperability and prior-authorisation rules are operative for impacted plans — 7-day routine and 72-hour urgent decision clocks, specific denial reasons, and appeal rights when a timeframe is missed. State-regulated plans differ.
Automated decision this documents: automated or criteria-driven prior-authorisation denial
Free path, in order (no cost):
- Your State Health Insurance Assistance Programme (SHIP) or state insurance department consumer service — free help
- The patient assistance programme or financial counsellor at the treating hospital
- LawHelp.org for free legal aid on a benefits denial
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
File the appeal, then call the plan's member services while the window is open; your state's free insurance counselling service or a legal-aid health unit can help with the paperwork at no cost.
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.