Apellica

Terms of Service

Last updated: 2026-05-17.Version: 2026-05-17 (v2).

Plain-English summary. Apellica, Inc. ("we", "Apellica") helps US patients fight denied health insurance claims. We are not a law firm and not a medical provider. You only pay us if we recover money for you, per the contingency schedule in our Assignment of Benefits. Disputes are resolved by informal discussion first and, if that fails, by individual binding arbitration. You keep every non-waivable consumer-protection right under your state's law.

1. Definitions

  • "Apellica", "we", "us", "our"— Apellica, Inc., a Delaware corporation, with customer-facing office at New York, NY, United States and registered office at New York, NY.
  • "Service"— the Apellica website at https://apellica.com, the customer case portal atcrm.apellica.com, the Assignment of Benefits ("AOB") signing experience, and all advocacy and recovery services Apellica performs on behalf of a patient under a signed AOB.
  • "Customer", "you"— the patient (or the patient's legal personal representative) who creates an Apellica account or signs an AOB.
  • "Carrier"— your health-insurance company, plan, or third-party administrator that issued the denial.
  • "Recovery"— money paid to you or to Apellica on your behalf as a result of Apellica's advocacy on a specific appealed claim, as defined in the AOB.

2. Eligibility

  • You must be 18 or older (or have a legal personal representative who is).
  • You must be a US resident with a denied health-insurance claim from a US carrier.
  • You must have the legal authority to authorize Apellica with respect to the appealed claim (you are the patient, or you have legal capacity to act for the patient under HIPAA §164.502(g) — e.g., parent of minor, guardian, healthcare proxy with documented authority).

3. What Apellica Is and Is Not

Apellica is an insurance-appeals advocacy service. We prepare and submit appeal letters, request medical records on your behalf, file external/ independent review where applicable, and communicate with your Carrier under the authority granted in your AOB.

Apellica is not:

  • A law firm. We do not provide legal advice. If your appeal escalates into litigation (for example, an ERISA §502(a)(1)(B) civil action on a self-funded plan under 29 USC §1132(a)(1)(B)), we will refer you to outside counsel.
  • A medical or behavioral-health provider. Our clinical analysis is for appeal argumentation only and is not a treatment recommendation.
  • An insurance carrier, plan administrator, broker, or insurance producer. We do not sell insurance.
  • A debt collector under the federal Fair Debt Collection Practices Act (15 USC §1692). We recover your benefits from your Carrier; we do not collect third-party debts.

4. Free Initial Review

A free review of your denial is a courtesy and does not by itself create a service engagement. Engagement begins only after you sign the AOB.

5. Account Responsibilities

  • Provide accurate identifying and claim information.
  • Authorize records access promptly when we request it (the AOB grants HIPAA- compliant authorization for specific records categories — see the AOB itself).
  • Meet any deadlines you are responsible for under your plan (we surface them on your case portal; the legal duty to meet them is yours).
  • Keep your contact email current — we use it for legal notices.

6. Fees and Payment

Apellica works on contingency.You owe nothing unless we recover. The fee schedule is set in your signed AOB and is summarized here:

Recovery on a single claimApellica feeLess than $2,500$99 minimum (or 100% of recovery if smaller)$2,500 through $25,00020% of recoveryGreater than $25,000$5,000 fee (capped — you keep everything above)

No setup fees, no monthly fees, no per-document fees, no records-retrieval fees. The contingency fee is the only money Apellica receives for the engagement. Payment terms: 30 days from invoice via ACH, wire, card, or check. Past-due invoices accrue interest at 1.0%/month or your state's maximum permitted rate, whichever is lower.

7. AOB Reference and Legal Authority to Act

Apellica acts on your behalf under the Assignment of Benefits and HIPAA Authorization you sign on this site. That document is the governing instrument for: (i) Apellica's authority to communicate with your Carrier; (ii) the contingency fee; (iii) your HIPAA authorization (45 CFR §164.508); (iv) cooling-off and revocation rights; and (v) per-state addenda. If anything in these Terms appears to conflict with your signed AOB, the AOB controls for the specific claim it covers.

8. Intellectual Property

All Apellica software, appeal templates, win-engine models, training data, algorithms, brand assets, and content on https://apellica.com are owned by Apellica or its licensors. We grant you a limited, non-exclusive, non-transferable license to view and use the Service for the purpose of pursuing your own denied claim. You may not republish, scrape, reverse-engineer, or use Apellica content to train a competing service.You own your own data— your case file, records, and anything you submit remain yours; Apellica's use of them is bound by the AOB and our Privacy Policy.

9. Carrier Names and Trademarks

Carrier names and logos are trademarks of their respective owners. Apellica's use of carrier names, short identifiers, or color-coded wordmarks is informational only — used to identify the specific carrier whose denial we are helping you appeal. Our use does not imply sponsorship, endorsement, affiliation, or partnership with any carrier. This is standard nominative fair use of third-party marks under US trademark law (see New Kids on the Block v. News America Publishing, 971 F.2d 302 (9th Cir. 1992)). Carrier rights-holders with concerns about mark display may contact legal@apellica.com.

10. Acceptable Use

You agree not to:

  • Submit false, misleading, or fraudulent claim information.
  • Impersonate another patient or pretend to be the patient's authorized representative when you are not.
  • Use Apellica to harass a Carrier or healthcare provider.
  • Attempt to access another customer's case data, scrape the Service, or interfere with its security.
  • Use the Service for any unlawful purpose.

11. No Guarantee; Disclaimer of Warranties

Apellica makes no guarantee that any specific appeal will be overturned. Outcomes depend on the Carrier, the underlying clinical facts, the governing plan terms, and applicable state and federal law. Historical win rates we publish are observations across a portfolio; they are not predictions for any individual case. Past results do not predict future outcomes.

EXCEPT AS EXPRESSLY STATED IN THESE TERMS OR YOUR AOB, THE SERVICE IS PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS. TO THE MAXIMUM EXTENT PERMITTED BY LAW, APELLICA DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT.

12. Limitation of Liability

To the maximum extent permitted by law, Apellica's aggregate liability for any claim arising from these Terms or the Service is limited to the greater of (i) the total fees Apellica has actually received from you in the twelve (12) months preceding the claim, or (ii) one hundred US dollars ($100). Apellica is not liable for indirect, incidental, special, consequential, exemplary, or punitive damages.

Exception: these limits do not apply to claims that cannot lawfully be limited (e.g., gross negligence, willful misconduct, violation of HIPAA, or non-waivable consumer-protection statutes in your state).

13. Indemnification

You agree to indemnify and hold Apellica harmless from claims arising out of (i) your breach of these Terms or the AOB, (ii) your provision of inaccurate or fraudulent information, or (iii) your unauthorized use of the Service. This indemnity does not apply to the extent the claim arises from Apellica's own negligence, willful misconduct, or violation of law.

14. Dispute Resolution

(a) Informal resolution first. Most disputes can be resolved quickly. Email legal@apellica.com. Neither party will begin arbitration or sue until at least thirty (30) days after written notice and a good-faith effort to resolve.

(b) Binding arbitration. If informal resolution fails, the dispute is referred to binding arbitration before a single arbitrator under the JAMS Consumer Arbitration Rules. Arbitration is conducted by video, or in person at the JAMS office nearest to your residence at your election. The arbitrator's award may be entered as a judgment in any court of competent jurisdiction.

(c) Class-action waiver. To the maximum extent permitted by law, each party waives the right to participate in a class action, class arbitration, or representative action. If a court holds this waiver unenforceable for any claim, that claim alone is excised and the remainder of this Section 14 remains in force.

(d) Small-claims carve-out. Either party may bring an individual action in small-claims court for any matter within that court's jurisdiction.

(e) Preserved consumer rights. Nothing in this Section 14 prevents you from filing a complaint with your state Department of Insurance, with your plan's external/independent review organization, with the federal Department of Labor (for ERISA plans), with the HHS Office for Civil Rights (for HIPAA), or with any other state or federal consumer-protection agency. Nothing waives any non-waivable statutory remedy.

15. Termination

  • By you. You may end your engagement at any time per the AOB revocation procedure. Revocation does not eliminate the fee on a Recovery the Carrier has already issued before the revocation date.
  • By Apellica. We may end an engagement on written notice if you breach these Terms or the AOB, if a conflict of interest emerges, or if we determine in good faith that the case cannot be ethically pursued. We will return your case file on request.
  • Survival. Sections 6 (Fees, for Recovery already accrued), 8 (IP), 11 (No Guarantee), 12 (Liability), 13 (Indemnification), 14 (Dispute Resolution), 18 (Governing Law), and 19 (General) survive termination.

16. Modifications to These Terms

Apellica will not retroactively change these Terms in a way that materially reduces your rights for an engagement already in progress. For prospective changes, we will post the new version here with a new Last updated date and (for material changes) email customers with an active case 30 days in advance.

17. Communications and Mobile Messaging

By creating an account or signing an AOB you consent to receive transactional emails and (if you opt in to SMS) text messages relating to your case at the contact details you provide. Message and data rates may apply. You can opt out of marketing email at any time using the link in the footer of any email or by replying STOP to a text message; transactional case-management messages will continue.

18. Governing Law

These Terms are governed by the laws of the State of Delaware (Apellica's state of incorporation) and applicable US federal law, without regard to conflict-of-law principles. To the extent a non-waivable consumer-protection statute of your state of residence applies, that statute controls over any inconsistent provision of these Terms.

19. General Provisions

  • Entire agreement. These Terms, together with your signed AOB and our Privacy Policy, are the entire agreement between you and Apellica.
  • Severability. If any provision is held unenforceable, the remaining provisions remain in force; the unenforceable provision is reformed to the minimum extent necessary.
  • No waiver. Failure to enforce a provision is not a waiver of the right to enforce it later.
  • Assignment. You may not assign these Terms. Apellica may assign in connection with a merger, acquisition, or sale of substantially all assets, on written notice to you.
  • Force majeure. Neither party is liable for delay or failure caused by events outside its reasonable control.
  • Notices. Notices to Apellica are effective when delivered to legal@apellica.com. Notices to you are effective when sent to the email on file.
  • Headings. Headings are for convenience and have no legal effect.

20. Contact

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