Comprehensive insurance services for your patients

Most providers already have a claims/appeals process. But, we are totally separate from that. Our services don’t intersect with your claims/appeals process.Even when we write appeals, the appeals we write are totally different than what providers write and submit. We advocate for better reimbursement by doing in-network treatment comparisons, describing relevant regulations that insurers are held to, and listing precedents for the insurer fully covering this procedure before.When needed, we also appeal denials from insurers (such as “not medically necessary” or “experimental”) when providers’ offices aren’t able to overturn an insurance denial with their own processes.

Very little. We can send you (both digitally and in the mail) handouts for your office to give to relevant patients. We can be helpful to all patients, but we especially recommend providing them to all patients who are out-of-network (and thus won’t receive 100% coverage by default) or who are experiencing insurance denials. We very strongly recommend that patients are referred to us at least one month before treatment takes place, as winning appeals is much more difficult post-treatment. We can still consider taking cases after treatment has taken place.

Our success rate varies depending on the type of case, with some case types achieving >90% success. By partnering with us, you benefit from the highest possible chances of a favorable outcome. We conduct a thorough assessment of your case upfront, and if the likelihood of success is low, we will inform you before proceeding.

No. Patients reach out to us directly, and any data needed from the provider’s office would be obtained from the patient directly, not us.

No, it won’t. When we petition with the patients for in-network coverage of an out-of-network treatment, insurance companies will sometimes offer the medical provider a Single-Case Agreement (SCA) for the patient’s individual case. These often reimburse the provider more than the negotiated in-network rate. Many providers like SCAs due to the increased rate, but some providers don’t sign them. It’s totally up to you!

None whatsoever. Our arrangement is such that provider offices refer patients to us, and then it’s up to the patient whether they want to reach out. When we’re working with your patients as clients, we don’t request any of their information from you directly. Everything goes through the patient, so if they need some records from your office, they (rather than us) communicate with you. The same norm applies to insurers: patients submit the appeal letters themselves and communicate with the insurer directly. All of this maximizes patient-autonomy.

It depends on the nature of each patient’s exact case. Regardless, they can fill out our contact form for a free informational phone call; we’ll give them advice even if we aren’t able to take them on as a client or if they choose not to use our service.

You can do it yourself, and in fact, we wrote a comprehensive guide for patients on how to write their own appeal letter, and we also wrote a guide on jaw surgery insurance coverage. But, most patients tend to want to use our appeal-writing services rather than writing the appeal themselves because (1) there is a significant amount of money at stake, (2) our “you only pay if we win” business model ensures there is no risk of wasting money, and (3) and appeals take lots of effort to write. (The best appeals are 15+ pages and people tend to find appeal-writing to be very boring, although we don’t!)

We have lots of experience! We began writing appeals in 2021, starting with appeals for our own surgeries. We have strategized with 40+ insurance experts to make sure our appeals and advocacy strategies are as robust as possible.

We are not lawyers. We do not provide legal counsel, and we do not assist people in pursuing legal action against insurers (for that, patients would need to contact a lawyer).We are patient advocates. Rather than provide legal assistance, we write appeals for people to submit to insurers. There is significant precedent for patient advocates doing this work for patients. Note that in many cases, lawyers won’t take on this kind of work. Anecdotally, this is because a patient can’t win more money than the cost of the procedure itself unless it can be proven that the insurer “acted in bad faith.”