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.