Your Health Insurance Claim Was Denied. It Doesn't Have to Stay That Way.
Coverage denials, claim rejections, authorization refusals, in-network disputes — insurers deny legitimate claims millions of times every year. Most people accept the denial. The ones who appeal — win far more often than they expect.
17% Claims denied annually
<0.1% Ever appeal
40–60% Of appeals succeed
No account needed · Results in 15 seconds · Free to start
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Federal Law Gives You the Right to Appeal Every Denial
Under the Affordable Care Act and ERISA, every adverse benefit determination is appealable. Your insurer must provide a written explanation of the denial, the clinical criteria applied, and your full appeal rights — including the right to external independent review. Most people never know they have these rights until someone tells them.
Three Common Health Insurance Denials — and Why They Are Overturnable
These are the most searched and most successfully appealed health insurance denials. Each one has clear legal and clinical grounds to challenge.
Not Medically Necessary · CO-50
Your claim was denied as "not medically necessary" — the single most common health insurance denial in the United States.
"This claim has been reviewed and determined to be not medically necessary under our clinical coverage criteria. Code CO-50 has been applied."
Why it overturns: CO-50 denials are based on automated clinical criteria reviews that frequently miss the full picture of your medical history. The insurer's reviewer never spoke with your physician. They applied proprietary guidelines — from companies like Milliman or InterQual — that may differ from the standards your physician follows. The most effective appeals cite the specific clinical criteria the reviewer applied and demonstrate, with your physician's documentation, how your case meets or exceeds those criteria. Cases where the insurer's stated reason is directly contradicted by the clinical record — for example, claiming conservative treatment was not attempted when your records show it was — are among the strongest appeal cases ClaimCompass handles.
88
Viability
Score
Emergency Care & Out-of-Network
Your emergency room visit or out-of-network care at an in-network facility was denied — or you received a surprise bill for care you couldn't control.
"Your claim has been processed at the out-of-network benefit level. You are responsible for the balance between our allowable amount and the provider's billed charge."
Why it overturns: The No Surprises Act, effective January 1, 2022, prohibits balance billing for emergency services at any facility and for out-of-network providers at in-network facilities who treated you without your knowledge or consent — including anesthesiologists, radiologists, and assistant surgeons. If any of these situations apply, the insurer cannot charge you more than your in-network cost-sharing, regardless of the provider's network status. Most people who receive surprise bills never know this federal protection exists. An appeal citing the No Surprises Act and the specific circumstances of your care has strong grounds in most situations.
85
Viability
Score
Prior Authorization Denied
Your insurer denied prior authorization for a procedure, specialist referral, or treatment your physician ordered.
"Your request for prior authorization for [procedure] has been denied. The clinical information provided does not support medical necessity under our coverage criteria."
Why it overturns: Prior authorization denials are based on clinical reviewers who never examined you and frequently applied criteria designed to minimize cost rather than reflect your clinical picture. The most powerful tool in a PA appeal is the peer-to-peer review — a direct conversation between your physician and the insurer's medical reviewer. Many PA denials are reversed during peer-to-peer before a formal written appeal is even filed. Request it immediately. If peer-to-peer does not resolve the denial, a formal written appeal citing your clinical history, the FDA-approved indications for the procedure, and the specific clinical criteria your insurer applied is the next step.
82
Viability
Score
Here's How It Works — Three Simple Steps
From denial letter to appeal-ready in about 3 minutes. No insurance expertise required.
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Upload Whatever You Received
Take a photo or upload a PDF — that's really all it takes.
Your Explanation of Benefits, denial letter, prior authorization rejection, claim summary — if it is official, confusing, and represents money you believe you shouldn't owe, ClaimCompass can read it. Your document is handled securely, encrypted in transit, and automatically deleted if you do not continue. No account needed to start.
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We Read It and Explain It
Within seconds — your denial decoded, your rights identified.
Our AI identifies the specific denial code applied, the clinical or administrative error it represents, and whether federal law — the ACA, No Surprises Act, ERISA, or Mental Health Parity Act — supports your appeal. You receive a viability score from 0 to 100, a plain-English explanation of exactly what went wrong, and your recommended next steps. This analysis is completely free — no payment, no sign-up required.
3
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Your Complete Appeal Letter Is Ready
Clinically cited, legally grounded, ready to send — for $49.
ClaimCompass generates a complete, formal appeal letter citing the specific clinical criteria your insurer applied, the evidence from your medical record that contradicts their determination, and the federal or state law that supports your appeal. Your Level 1 appeal, Level 2 escalation letter, and external independent review request are all included in your single $49 payment. No subscription. No additional charge if the denial is upheld and you need to escalate.
What Does a High Viability Score Mean?
A score above 70 means you have a solid case worth pursuing. A score of 90 or higher — which we see frequently in cases where the insurer's stated reason is directly contradicted by your clinical record — means the denial has a real error that a reviewer must address. In those cases, fighting back isn't just possible. It's likely to work.
90–100
Strong factual or legal error — fighting back is very likely to work
70–89
Solid case — strong grounds for formal appeal
50–69
Possible — depends on documentation and clinical specifics
95 /100
Appeal Viability Score
🟢 Factual contradiction found
95 /100
Viability Score
🟢 Fight back
Ready to Fight Back? Start Here — It's Free.
Upload your health insurance denial. In under a minute, you'll know exactly where you stand — and whether federal law is on your side.
Free to analyze · $49 complete appeal · No subscription · All escalation levels included