Field notes

What we've learned navigating denials.

Tactics, denial-code playbooks, and the patterns we see across 50+ carriers. Honest, specific, no fluff.

Why fewer than 1% of denied claims are ever appealed

The system runs on the bet that you'll give up. Here's how that bet got built — and why it works on almost everyone.

BMI thresholds, T2D pathways, formulary exceptions. The three angles that win most GLP-1 appeals — and the one that wins them faster.

Level 1 reverses 41%. Level 2 (Maximus) reverses higher. Level 3 (ALJ) is where the real wins happen. Here's the full ladder.

Appeals aren't pleas. They're rebuttals. Five things every winning letter has — and the one phrase that does most of the work.

Most 'denials' are actually prior-auth refusals — and there's a separate, faster path to reverse them. Most patients don't know it exists.