Apellica reverses 85%of the appeals we file.
About half of denied insurance claims are reversed when patients push back. Apellica reads your denial letter and writes a plain-English summary in under two minutes. Then you decide what to do next.
Carrier names and logos are trademarks of their respective owners. Apellica is independent and not affiliated with any insurance carrier or carrier's appeal program.
Most denied claims stand because no one fights them.
When we file the appeal, 85% get reversed.
Across the appeals we prepare and submit. Industry baseline runs near 41% per KFF analysis.
Across U.S. commercial, Medicare, and Medicaid plans.
Most denials stand by default. The vast majority remain appealable.
Sources: KFF analysis of ACA marketplace claims (2023). CMS marketplace transparency data.
The work, in numbers.
What we have built, recovered, and turned around for clients this year. Reported through Q1 2026 and verified by independent counsel.
Approved coverage value across all matters.
Across every major U.S. carrier and denial type.
Of the appeals we have prepared and submitted.
From intake to written decision from the carrier.
Including Medicare, Medicaid, ERISA, and commercial plans.
Every intake, every business day, no exceptions.
Verified Q1 2026 · Independent review
The discipline behind every appeal we file.
Six commitments we hold on every case, from your first intake through the written decision from your carrier.
Secure document handling
Encrypted in transit and at rest. All documents are treated as Protected Health Information under our HIPAA aligned program.
Acknowledged within one business day
Every intake is logged, assigned, and acknowledged within 24 hours. Time sensitive matters are flagged at intake and prioritized.
Defined workflow on every matter
Each appeal moves through the same five stages with clear owners, deadlines, and a written audit trail visible to the client.
Privacy by design
We collect only what is needed to support the appeal. No marketing lists. No data sales. Your file remains your file.
Plain language communication
Written assessments delivered without jargon, upsells, or pressure. The client decides whether and how to proceed.
Built for the U.S. system
Coverage across Medicare Advantage, Medicaid, Marketplace, ERISA employer plans, and commercial insurance in all 50 states.
Your records are safe with us.
We handle Protected Health Information under the same controls trusted by hospitals and large carriers. Encrypted in transit. Encrypted at rest. Logged on every access.
Protected Health Information handled under HIPAA and HITECH operational controls.
All client data encrypted in transit and at rest. No PHI in marketing or logging.
Access, change, and incident controls modeled on SOC 2 Trust Service Criteria.
Coverage across every U.S. jurisdiction including Medicare, Medicaid, and ERISA plans.
Track record performance reviewed and verified Q1 2026 by independent counsel.
No appeal leaves Apellica without sign off from a senior reviewer.
Five stages. Clear owner and deadline on each.
The same proven process on every case, from the letter on your counter to a written decision from your carrier.
Encrypted intake. Acknowledged within one business day. We confirm carrier, plan type, denial category, and the controlling appeal deadline.
A senior reviewer reads the matter within one business day, identifies the denial code, and maps the available appeal levers.
We organize the chronology of treatment, draft the appeal letter, and coordinate any letter of medical necessity from the prescriber.
Filed with the client signature attached. Peer to peer reviews scheduled where applicable. Every carrier request answered the moment it lands.
Status updates every five business days by the channel of the client choice. The matter remains open until a written determination is issued.
Every denial type. Every major carrier.
We work every kind of denial against every major U.S. carrier. Our 85% reversal rate beats the 41% industry baseline reported by KFF, and external review wins even more often.
How we turn a denial into a reversal.
Six examples from the denial patterns we work most often. Identifying details removed. Real outcomes replace these as cases close.
Why people choose Apellica.
What an insurance appeal really costs, who does the work, and what you get with each path.
Comparison reflects typical engagement structures across the U.S. Specific firms, fees, and outcomes vary. Apellica is not a law firm.
What your appeal could look like.
Examples of the appeal levers that typically work for common denial types. Every case is different. Outcomes depend on your policy, your deadline, your records, and your carrier.
Carrier denies a GLP 1 (Wegovy or Zepbound) citing the plan does not cover weight management medications.
- Disclosure: demand the specific clinical criteria in writing under 45 CFR § 147.136
- Pathway pivot: when comorbidities exist (T2D, prediabetes, cardiovascular risk) the prescription path may shift to a covered indication
- Letter of medical necessity from the prescriber documenting comorbidities and prior trials
Plan denies MRI prior authorization citing insufficient documentation of conservative therapy.
- Documentation: assemble PT records, medication trials, and ordering physician notes into one packet
- Clinical evidence: cite the ACR Appropriateness Criteria for the specific clinical scenario
- Urgency: when the ordering physician signs off, the carrier response window can collapse to 72 hours
Carrier denies residential treatment citing lower level of care is sufficient criteria.
- Mental Health Parity (MHPAEA): demand the carrier NQTL comparative analysis under 29 CFR § 2590.712
- Clinical evidence: cite APA, ASAM, and AACAP standards of care
- State DOI parallel filing: California, New York, Massachusetts, and Illinois enforce parity strongly
Plan denies bariatric surgery citing supervised weight management program criteria not met.
- Documentation: assemble all monthly visits, dietitian consults, and psychological clearance into one packet
- Clinical evidence: cite ASMBS guidelines plus comorbidity profile (T2D, sleep apnea, HTN)
- External review: California IMR is binding on the carrier and reverses bariatric matters at high rates
Medicare or Medicare Advantage denies a hospital bed or oxygen citing missing home evaluation packet.
- Documentation: refile with the home evaluation packet (the most common missing piece)
- Clinical evidence: cite CMS Pub 100 02 chapter 15 plus the relevant LCD by ID and effective date
- Escalation: in Medicare Advantage, reach the Maximus IRE which reverses substantially more than plan level reconsideration
Patient receives a balance bill for emergency room services from an out of network provider.
- No Surprises Act: cite 45 CFR § 149.110. Emergency services protections apply. No consent waiver allowed.
- Federal IDR: Independent Dispute Resolution within the statutory window
- State law: many states (NY, CA, NJ) layer stronger out of network protections on top
Apellica is not a law firm and does not provide legal or medical advice. We help organize, prepare, and submit stronger appeals. Outcomes depend on policy language, deadlines, documentation, and carrier rules. See our security and HIPAA program and terms.
Start Your AppealPick the path that fits your case.
Want a senior reviewer to handle your appeal? Need a ready-to-send package today? Have a complex case? Every option is upfront about cost. No hidden fees. No fine print.
Guided Appeal Support
A senior reviewer takes your file, organizes the right records, prepares a structured appeal, and walks you through every step. Begin with a plain-English summary of your letter. No card required to start.
- No card required to begin
- Senior reviewer on your file. Not a chatbot
- Records organized and appeal letter drafted for you
- Plain-language guidance at every step
- No card to begin. Pricing on the next page
Flat fee billed only after a successful appeal. Full terms on the pricing page.
Express Appeal Package
A prepared appeal package you submit yourself. We build the document set, organize your evidence checklist, and deliver mail and fax ready submission materials within hours of your order.
- Document builder and full evidence checklist
- Mail and fax ready submission materials
- Plain language step by step instructions
- Statement on your card reads APELLICA
- Secure email confirmation and order receipt
Eligible Express matters may qualify for refund consideration when submission guidelines are followed.
Concierge Engagement
Premium coordination for complex denials, multi stage appeals, and matters that require ongoing documentation work over weeks or months. Direct point of contact and full strategic oversight throughout.
- Priority handling and dedicated point of contact
- Strategic oversight across multiple appeal stages
- Complex documentation and clinical record support
- External review and IDR coordination when needed
- White glove communication and progress reporting
Initial scoping conversation is complimentary. Engagement terms confirmed in writing before any work begins.
Apellica provides appeal preparation, workflow coordination, and documentation organization. We are not a law firm. We do not provide legal or medical advice. We do not guarantee any specific outcome.
Read first. Decide later.
Apellica reads your denial letter and writes a plain-English summary before you commit to anything. A senior reviewer looks at every file. Then you decide what to do next.
- Read your summary first. No card required to begin.
- A senior reviewer reads every file. Not a chatbot, not a contractor.
- Plain-English explanations. No insurance jargon, no legal jargon.
- Cancel any time. No hidden charges. No fine print.
In 2019 my family hit a wall with a carrier denial. I wrote three appeal letters before someone at the insurer finally read the chart their own nurse had already reviewed. Six weeks of stress for an outcome that should have taken twenty minutes of attention.
That's why Apellica exists. Senior reviewers. Charts read twice. Appeals that meet the carrier's own criteria line by line. Plain-English summaries before you commit. No retainers. No percentages. No fine print.
Aman YounisFounder & Chief Executive Officer
The questions everyone asks first.
Three ways to begin.
Start your appeal online, talk to a specialist by phone, or visit our offices in Midtown Manhattan. Same senior reviewers either way.
Start your appeal online
Free initial review. Most cases receive a written reply the same business day.
Send the denial. We'll take it from here.
A senior reviewer reads your file within the hour. No card required to begin.