Meet the Apellica team.
37 professionals across leadership, clinical review, senior appeal handling, operations, engineering, and outside counsel. Every appeal Apellica files is built on the work of this team and signed off by a senior reviewer.
Sets firm strategy and oversees all client engagements. Personally reviews every escalated matter.
Designs the operational and technology stack across intake, evidence handling, and secure infrastructure.
Runs day to day firm operations, queue health, SLA compliance, and reviewer assignments across all 50 states.
Board certified internal medicine. Oversees clinical review standards and medical necessity arguments.
Leads firm legal operations, regulatory compliance, ERISA appeals strategy, and engagement structure.
Owns HIPAA compliance, audit readiness, and the firm wide privacy and security program.
Oversees clinical review across all denial categories. Twenty years of internal medicine practice.
Reviews oncology, complex surgical, and high cost specialty drug appeals.
Specialty drug formulary appeals, GLP 1 coverage, prior authorization pathways.
Mental health, behavioral health parity, residential treatment, and ABA therapy appeals.
Cardiology, imaging, and prior authorization clinical review.
UnitedHealth and Aetna commercial denials. Twelve years of insurance operations experience.
Cigna and Humana specialty drug appeals. Former carrier appeals analyst.
BCBS commercial and Medicare Advantage. Specializes in clinical necessity disputes.
Drafts the appeal letter and coordinates the carrier submission for complex matters.
Medical record assembly, evidence indexing, and quality review across all engagements.
ERISA and self funded employer plan appeals. Section 1557 and parity matters.
Medicare Advantage internal and IRE appeals. Five state coverage focus.
Surgical and procedural denials. Peer to peer scheduling and clinical packet preparation.
Imaging, DME, and prior authorization. Urgent designation strategy.
Out of network billing, No Surprises Act, and federal IDR coordination.
Commercial PPO and HMO appeals. State external review coordination.
Medicaid managed care and dual eligible matters across multiple states.
Owns intake throughput, queue assignment, and SLA performance across the reviewer team.
Manages the privacy program, breach response readiness, and PHI access controls.
Senior level QA on every appeal package before it leaves Apellica. Reviewer coaching.
First contact, triage, and matter assignment for every new client engagement.
Client communications, status updates, and the post submission follow through experience.
Reporting, audit trail integrity, and cross functional metrics for the partner team.
Builds and operates the Apellica platform: intake, evidence portal, workflow, and reporting.
Owns the security program, encryption posture, access control, and audit logging.
Workflow engine, evidence pipeline, and the secure portal experience.
Uptime, deployment, and the integrity of the production environment.
Outside healthcare litigation counsel. Advises on complex appeals, regulatory exposure, and external review strategy.
Surgical second opinion advisor. Bariatric, orthopedic, and oncology surgical denial review.
Twenty five years inside carrier operations. Advises on internal appeal processes and procedural levers.
Specialty pharmacy formulary advisor. Tier exception strategy and manufacturer documentation.
Apellica's professional team includes employees, contractors, of counsel, and outside advisors. Specific reviewer assignment for any matter is confirmed at intake. The firm is not a law firm and does not provide legal or medical advice. Outside counsel and medical advisors are engaged in advisory capacity only.