About half of appealed denials get overturned — and almost nobody appeals. The letter hides the reason in codes and the deadline in fine print. Paste it. You get the reason in plain words, your two appeals with the dates computed, the records to request, and an appeal letter built around what the plan actually has to consider.
Free decode
The letter or EOB: the date, the denial reason or code, the service, the plan type. Tell us what the doctor says.
Why this exists
A missing prior authorisation, a wrong code, a 'not medically necessary' from a reviewer who never saw the chart. The appeal process exists precisely for that — and it has deadlines that favour the patient if you know them.
How it works
Date, reason code, service, plan type. What the doctor says.
What the code means, whether it's paperwork or a medical judgement, your internal and external appeal rights with the dates computed, and the documents the plan must give you free.
A letter that hits what the plan has to consider: the clinical criteria, the doctor's rationale, the prior-auth facts, and a request for the reviewer's credentials and the guideline used.
Plans
For one patient. Clinics, billing advocates and unions license it for everyone they help.
Your appeal letter with the medical-necessity points for the doctor's signature, a records-request letter (claim file, criteria, reviewer credentials), a deadline calendar, and the external-review request steps.
Branded decoder for your patients or members; your billing office as the 'next step'.
All prices in USD, handled by Stripe. The free decode never goes behind a paywall.
Common questions
The tool describes itself as a free decode of your denial or explanation of benefits. The material doesn't say anything about storing or saving what you paste, so if you're worried about privacy, don't include more personal information than necessary. This is not legal or medical advice, and the tool can't see your actual plan document.
You get the real reason for the denial explained in plain words (things like medical necessity, prior authorization, out-of-network, coding, or 'experimental'), your appeal rights under the ACA and Florida law, the deadlines calculated from your letter's date, what records to request from the plan, and a draft appeal letter with medical-necessity points your doctor can sign.
Based on the tool's material, you generally have 180 days for the internal appeal and 4 months for external review, with both deadlines computed from the date on your denial letter. Confirm the exact dates in your own letter and with your plan, since the tool cannot see your plan document.
No — the tool explains ACA, ERISA and Florida appeal rules for employer and marketplace plans, but it is not legal or medical advice and does not file appeals. For free help, the material lists the Florida Division of Consumer Services (1-877-693-5236) and, for employer plans, the U.S. DOL EBSA (1-866-444-3272).
No. This tool covers commercial plans — employer, ACA marketplace, and individual health plans — and does not cover Medicare, Medicare Advantage, or Medicaid fee-for-service, which have their own appeal systems. If you have a Medicare denial, the material directs you to use Medicare Decoder instead.
La herramienta se describe como una decodificación gratuita de su carta de denegación o explicación de beneficios. El material no indica si se guarda o almacena lo que usted pega, así que si le preocupa la privacidad, le recomendamos no incluir más información personal de la necesaria. Esto no es asesoría legal ni médica, y la herramienta no puede ver el documento real de su plan.
Usted recibe la razón real de la denegación explicada en palabras sencillas (por ejemplo, necesidad médica, autorización previa, fuera de la red, codificación o 'experimental'), sus derechos de apelación bajo la ACA y la ley de la Florida, los plazos calculados a partir de la fecha de su carta, qué documentos solicitar al plan, y un borrador de carta de apelación con los puntos de necesidad médica que su médico puede firmar.
Según el material de la herramienta, generalmente usted tiene 180 días para la apelación interna y 4 meses para la revisión externa, calculados ambos a partir de la fecha de su carta de denegación. Confirme las fechas exactas en su propia carta y con su plan, ya que la herramienta no puede ver el documento de su plan.
No — la herramienta explica las reglas de apelación de la ACA, ERISA y la Florida para planes de empleador y del mercado, pero no es asesoría legal ni médica y no presenta apelaciones. Para ayuda gratuita, el material menciona la Florida Division of Consumer Services (1-877-693-5236) y, para planes de empleador, el U.S. DOL EBSA (1-866-444-3272).
No. Esta herramienta cubre planes comerciales — de empleador, del mercado de la ACA e individuales — y no cubre Medicare, Medicare Advantage ni Medicaid de pago por servicio, los cuales tienen sus propios sistemas de apelación. Si su denegación es de Medicare, el material indica que debe usar Medicare Decoder en su lugar.
Built by the same team, free to try.