Your denial letter is not the final answer.

Every plan has an internal appeal — and if that fails, an external review by an independent reviewer. Both have deadlines. Apelo runs both stages for you: your case built on your plan's own rules, every letter drafted, every deadline tracked, and the fight carried to the last level available.

What Apelo does

1

An appeals specialist reads the denial reason code on your letter — not the form language, the actual reason it was refused.

2

A clinical reviewer weighs your records against the plan's own medical-necessity criteria and writes the clinical argument.

3

We track your deadline, so nothing lapses while you're still gathering records.

4

Your appeal goes out citing the plan's own terms and the criteria it already agreed to — and if the internal appeal fails, we take it to independent external review.

What the letter looks like

RE: APPEAL OF CLAIM #48213-A Illustrative example

Dear Claims Review Department, I am appealing the denial of the above claim. Your letter cites not medically necessary as the reason. Per Plan Clause 4.2(b), this procedure is covered when the enrolled member's treating physician documents the criteria below — which my physician's records already confirm.

I request reversal of this denial and reprocessing of the claim under my plan's own coverage terms. If this internal appeal is not granted, I intend to request an independent external review.

Appeal windows are measured in days, not months.

~180 days

typical window to file an internal appeal

~4 months

typical window to request external review after

72 hrs

decision time for urgent, expedited appeals

Deadlines vary by plan and state — Apelo checks yours against your actual denial letter.

Pricing

Standard appeal

$49

For a straightforward denial — reason code, plan language, drafted letter.

Complex / prior-auth

$99

For prior-authorization denials and multi-document cases.

Founding

Household plan

$19 /mo

Unlimited appeals for recurring denials across your household.

Appeals FAQ

Prior-authorization denials, medical-necessity denials, coding and administrative denials, and out-of-network determinations you believe are wrong.

If your internal appeal is denied, Apelo drafts your external-review request — a review by an independent party, not your insurer.

Your denial letter states your window. Apelo reads it from your letter and flags how much time you actually have left.

Yes — it has the claim number, reason code, and deadline Apelo needs to draft an accurate appeal.

No. We track the response, tell you what it actually means, and if the answer is still no we prepare the next level — including the independent external review — so your case doesn't stop at the first denial.

No reduction, no fee.

If Apelo doesn't bring down what you owe — a denial overturned or a bill corrected — you get your money back. We refund your Apelo fee in full.

Your window is open. Use it.