Appeal My Claim

Reviewed 1d ago.

• tools: 4 tools scanned
• metadata: scanned

No findings.

Tools (4)

• get_appeal_rights

  Appeal rights, steps and free help for a plan type and state. For requests like "what are my appeal rights in California?", "my insurer denied my claim, what can I do?" or "how do Medicare appeals work?". Returns who decides, the steps (internal appeal, external review, Medicare levels or Medicaid fair hearing), deadlines, and where to get free help, including the state insurance department. If the plan type is not known, leave it out to get the rules for most private plans.

• get_appeal_deadlines

  How long someone has to appeal, and how fast the plan must decide. For requests like "how long do I have to appeal?", "when is my appeal due?" or "how fast does my insurer have to answer?". With the date on the denial notice, gives an approximate file-by date. The date on the user's own notice is the one that counts.

• explain_denial_code

  Explain the denial codes on an Explanation of Benefits. For requests like "my EOB says CO-50, what does that mean?", "what is denial code PR 204?" or "what does N130 mean?". Returns each code in plain words, who usually fixes it (the provider's billing office, an appeal, or the user), whether the provider can bill the user for it (from the group code CO, PR, OA or PI), and a letter link when an appeal fits.

• draft_appeal_letter

  Draft an appeal letter for the user to review and send. For requests like "my insurer denied my MRI as not medically necessary, help me appeal" or "write an appeal letter for an out-of-network denial". Returns a letter as plain text with [brackets] for anything not given, a checklist of what to attach (denial notice, doctor's letter of medical necessity, records), and tips. It never sends or files anything.