About AppealGen
Built for Patients Who
Were Told No
AppealGen is an administrative documentation tool that helps patients and caregivers construct structured, evidence-based appeal letters when their health insurance claims are denied. We exist because the system was designed to make giving up easier than fighting back.
Why We Built This
Insurance claim denials affect 1 in 5 insured adults every year in the United States. Less than 1% of those patients ever file a formal appeal — not because appeals don't work, but because the process is deliberately complex, time-consuming, and intimidating.
When denials are challenged with proper documentation, overturn rates exceed 70% for medical necessity denials and reach 83% for prior authorization appeals. The gap between those numbers — 99% who don't appeal, 70–83% who would win if they did — represents hundreds of thousands of people who gave up on care they were entitled to.
AppealGen closes that gap. We generate procedurally structured appeal letters calibrated to the clinical data available — whether that's minimal (a procedural argument) or comprehensive (a full evidence-based clinical rebuttal).
Our Approach
We use a two-tier appeal methodology. When clinical data is limited, we generate a procedural appeal arguing incomplete review and deference to treating physician judgment. When full clinical details are provided, we generate a comprehensive evidence-based appeal that directly rebuts the denial rationale with medical facts.
Neither approach speculates, fabricates, or inserts placeholder text. What goes in is what comes out — properly structured, formally formatted, and ready to submit.
01
Accuracy Over Persuasion
We only include information the patient provides. No fabricated clinical details, no invented guidelines, no bracket placeholders.
02
Procedural Integrity
Every letter is formatted for insurance review boards — correct structure, correct tone, correct legal framing for formal appeals processes.
03
No Permanent Storage
Medical information is processed transiently during your session and deleted thereafter. We do not build databases of patient health data.
04
Transparent Limitations
AppealGen does not guarantee outcomes. Appeals depend on clinical facts, insurer policies, and submission quality. We provide the best possible document — the decision is theirs.
Regulatory Disclaimer
AppealGen is an administrative documentation service. It does not constitute legal advice, medical advice, or a guarantee of insurance approval. All generated letters must be reviewed by the patient and, where appropriate, a qualified healthcare provider before submission. Users retain full responsibility for the accuracy of submitted information.
Who AppealGen Is For
AppealGen is designed for US patients who have received a written insurance denial and need to file a formal internal appeal with their health insurer. This includes denials for medical necessity, prior authorization, out-of-network services, experimental treatments, and durable medical equipment.
You do not need a lawyer, a healthcare advocate, or any prior knowledge of insurance law to use AppealGen. The tool is built around the same procedural frameworks that patient advocates and healthcare attorneys use — structured for the review boards that actually make approval decisions.
If you received an Explanation of Benefits (EOB) with a denial code, or a formal denial letter from your insurer, AppealGen can help you respond. The average appeal letter takes 10 minutes to generate and can be submitted the same day.
Frequently Asked Questions
Can I appeal a denied health insurance claim?
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Yes. Under the Affordable Care Act (ACA) and ERISA, every insured patient has the right to appeal a denied health insurance claim. You typically have 180 days from the date of denial to file an internal appeal. Studies show overturn rates exceed 70% for medical necessity denials when filed with proper documentation.
What should an insurance appeal letter include?
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An effective appeal letter should include your policy and claim number, a direct rebuttal of the denial reason using clinical evidence, physician notes and test results, references to clinical guidelines supporting medical necessity, and your treating physician’s professional judgment. AppealGen structures all of this automatically.
How long do I have to appeal an insurance denial?
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Most health insurance plans allow 180 days (6 months) from the denial notice to file an internal appeal. For urgent medical situations you may be entitled to an expedited decision within 72 hours. Always check your Explanation of Benefits (EOB) or denial letter for your exact deadline.
What is the success rate of insurance appeals?
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According to KFF data, insurers overturn their own denials in 59% of internal appeal cases. Medical necessity denials appealed with full clinical documentation have overturn rates of 70–83%. The key is submitting a well-documented letter that directly rebuts the specific denial reason.
How does AppealGen work?
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Upload your denial letter or describe your situation, answer a few questions about your medical case, and AppealGen generates a complete appeal letter tailored to your specific denial reason — formatted to meet insurance review board standards with evidence-based arguments and proper procedural language. Download as PDF and submit directly to your insurer.
Is AppealGen free to use?
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Yes, AppealGen is free to start. Generate a complete, professionally written insurance appeal letter at no cost — no account required, no payment information needed.