How to fight a denial — by treatment, drug, or reason.
Plain-language playbooks. The exact policy citations and counter-arguments insurers respect, written by people who’ve done it.
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Browse by treatment
90 guides — every treatment we cover, with the policy citations and counter-arguments to use.
Adult ADHD medications
AI-drafted appeals citing DSM-5-TR, FDA labeling, and the Cortese 2018 Lancet meta-analysis. Built for adult ADHD denials: age-of-onset, step therapy, dose caps, post-shortage substitutions.
Read guide →Adult CAR-T cell therapy
Yescarta. Kymriah. Tecartus. Breyanzi. Carvykti. Abecma. Insurers love to demand auto-HSCT first, call CAR-T 'investigational,' or refuse out-of-network authorized centers — but ZUMA-7, TRANSFORM, CARTITUDE-4, and KarMMa-3 made CAR-T standard 2L care. Cancer = automatic urgent appeal. We turn pivotal trials + NCCN + CMS NCD into a board-ready letter in 24h.
Read guide →Amyloidosis (cardiac ATTR + AL)
Tafamidis. Acoramidis. Vutrisiran. D-VCd. Tafamidis runs ~$225,000/yr — payers fight harder than almost any other cardiology drug. We turn ATTR-ACT, ATTRibute-CM, HELIOS-B, ANDROMEDA, the 2022 ACC/AHA/HFSA HF Guideline (Class IIa for tafamidis), the ESC 2023 ATTR-CM expert consensus, and the Gillmore 2016 non-invasive diagnostic algorithm into a board-ready appeal.
Read guide →Asthma & severe allergies
Xolair. Dupixent. Nucala. Tezspire. Neffy. Palforzia. Allergy shots. Insurers default to step-therapy that ignores NAEPP 2020, GINA 2024, and the AAAAI/ACAAI Practice Parameters. We turn pivotal-trial data + practice guidelines into a board-ready appeal letter.
Read guide →Atopic dermatitis (AD / eczema)
Dupixent. Adbry. Ebglyss. Nemluvio. Cibinqo. Rinvoq. Opzelura. Insurers love to force step-therapy through Dupixent before approving Adbry, Ebglyss, or a JAK — but AAD 2024 lists these as PARALLEL options, not a forced sequence. Special-site disease, NRS pruritus, and DLQI qualify regardless of BSA. We turn SOLO-1/2, ECZTRA, ADvocate, ARCADIA, JADE COMPARE, and Heads Up data into a board-ready appeal.
Read guide →Autoimmune cytopenias (ITP + AIHA)
TPO-RAs. Tavalisse. Wayrilz. Enjaymo. Rituximab. IVIG. Splenectomy. Insurers love to gatekeep — 'fail splenectomy first', 'rituximab is off-label', 'try eltrombopag before romiplostim'. ASH 2019, ICR 2019, AABB AIHA, and Hill BJH 2024 list these as PARALLEL second-line options, not a forced ladder. We turn RAISE, FIT-1/2/3, LUNA-3, CARDINAL, and CADENZA into a board-ready appeal.
Read guide →Bariatric surgery — RYGB, sleeve, duodenal switch, SADI-S, revision, ESG
AI-drafted appeals for RYGB, sleeve, duodenal switch, SADI-S, ESG, and revision bariatric denials — citing ASMBS 2022 Position Statement (BMI thresholds), AAP / ASMBS 2023 adolescent guideline, IFSO consensus, ACS-MBSAQIP standards, and your insurer's exact policy.
Read guide →Bone marrow transplant (allogeneic HSCT)
Allo-HSCT for AML CR1, MDS, ALL, sickle cell, severe aplastic anemia. Haplo PT-Cy. Cord blood + Omisirge. Steroid-refractory GVHD with Jakafi / Rezurock / Niktimvo. VOD/SOS with Defitelio. Out-of-state Center of Excellence access. Insurers love to deny based on age, donor type, or out-of-state referrals — but CMS NCD 110.8.1 + ASTCT consensus + CIBMTR registry data + REACH-2 / REACH-3 / ROCKstar / AGAVE-201 / V005 turn most denials. We turn HCT-CI risk stratification + RIC eligibility + Haplo PT-Cy outcomes into a board-ready letter.
Read guide →BPH procedures + medical therapy
UroLift. Rezum. Aquablation. Optilume. HoLEP. PAE. Insurers love to label FDA-approved BPH procedures 'experimental' five to ten years after FDA clearance and pivotal-RCT publication. AUA 2018 + 2023 amendment endorse all of them. We turn LIFT, Rezum II, WATER, WATER-II, PINNACLE, GOLIATH, MTOPS and CombAT data into a board-ready appeal.
Read guide →C. difficile infection
Fidaxomicin. Bezlotoxumab. Rebyota. Vowst. Insurers love to force step-therapy through generic vancomycin or claim fecal microbiota products are 'experimental' — but IDSA/SHEA 2021 names fidaxomicin PREFERRED for both initial and recurrent CDI, and Rebyota (Nov 2022) + Vowst (Apr 2023) are FDA-approved. We turn OPT-80, EXTEND, MODIFY I/II, PUNCH CD3, and ECOSPOR III into a board-ready appeal.
Read guide →Cancer treatments
We generate a physician-ready appeal citing NCCN Guidelines, FDA labeling, ASTRO/ACR criteria, and 42 USC §1395x(t)(2) off-label compendium statute — with the right expedited-review language to invoke the federal 72-hour decision deadline when treatment cannot wait.
Read guide →Cardiac devices & procedures
AI-drafted appeals for denied cardiac devices and procedures — ICDs, TAVR, Watchman, MitraClip, LVAD, EP ablations. Every letter built on CMS NCDs 20.4 / 20.32 / 20.33 / 20.34, ACC/AHA guidelines, and pivotal trials.
Read guide →Cardiology drugs
AI-drafted appeals for PCSK9 inhibitors, Entresto, SGLT2 inhibitors, tafamidis, Camzyos, and the cardio-metabolic drugs insurers love to deny — built on AHA/ACC guidelines and the trials behind them.
Read guide →Chronic wound care
HBOT. Wound vac (NPWT). Apligraf / Dermagraft / EpiFix. Total contact casting. Insurers cite CMS LCDs to deny — but the LCDs themselves grant coverage when documentation is right. We turn Faglia, Armstrong-Lancet, Veves, Marston, Zelen, IWGDF/IDSA 2023, SVS 2016, and Wound Healing Society 2024 into a board-ready appeal.
Read guide →Compounded GLP-1
When the FDA shortage list closed for semaglutide (Feb 2025) and tirzepatide (Dec 2024), millions of patients on compounded GLP-1s through Hims, Henry Meds, Mochi, Eden, Ro, and Future hit a wall. Insurers reflexively deny compounded as 'investigational' / 'non-FDA-approved.' Self-funded employer plans carve out weight-loss drugs entirely. Anyone who paid cash during the shortage is told reimbursement is impossible — it often isn't. We turn 21 USC §353a, ACA external-review rights, SELECT trial, continuity-of-care, and your specific plan documents into a board-ready appeal.
Read guide →Compounded medications (non-GLP-1) — BHRT, LDN, ketamine, custom-dose pediatrics
AI-drafted appeals for BHRT, low-dose naltrexone, compounded ketamine, custom-dose pediatric, topical pain cream, and other compounded prescription denials — citing USP General Chapters 795 / 797 / 800, FDA Drug Quality and Security Act §503A and §503B, the FDA bulks list, the 'demonstrably difficult to compound' list, and your insurer's exact policy.
Read guide →Continuous glucose monitors & insulin pumps
AI-drafted appeals citing ADA Standards of Care 2025, Medicare LCD L33822, ATTD AID Consensus 2023, and pivotal CGM/AID trials — built for Dexcom, Libre, Omnipod 5, t:slim X2, Tandem Mobi, MiniMed 780G, and iLet denials.
Read guide →COPD severe + alpha-1 antitrypsin deficiency
Dupixent for COPD. Ohtuvayre. Trelegy. Breztri. Prolastin-C. Zephyr Valves. The first biologic for COPD landed in September 2024. The first novel COPD inhaled mechanism in 20+ years arrived in June 2024. Insurers are still defaulting to step-therapy that doesn't reflect GOLD 2024. We turn GOLD, ATS/ERS, and pivotal-trial data into a board-ready appeal.
Read guide →Cystic fibrosis & pulmonary fibrosis
AI-drafted appeal letters for Trikafta, Ofev, Esbriet, Kalydeco and every other CFTR modulator and antifibrotic — CFF and ATS guideline-grounded.
Read guide →Dental — medical necessity, oral surgery, TMJ, cleft palate
From TMJ surgery and cleft palate to pre-transplant dental clearance, we draft appeals that reframe 'dental' denials as the medical necessities they are — citing the 2023 CMS rule, 42 CFR §411.15(i), DC/TMD, and AAOMS Parameters of Care.
Read guide →Diabetes drugs & insulin
38 million Americans live with diabetes. Insurers deny insulin analogs, GLP-1s for T2D, SGLT2s, and pump supplies every day — even when ADA Standards of Care 2025, KDIGO 2024, and pivotal CV outcome trials say they shouldn't. We turn those guidelines into a board-ready appeal letter.
Read guide →DME — wheelchairs, prosthetics, orthotics
AI-drafted appeal letters that cite the right LCD, the right K-level, and the right MRADL evidence — for UHC, Aetna, Cigna, BCBS, Humana, and Medicare.
Read guide →Eating disorders — residential / PHP / IOP
Insurers routinely deny residential, PHP, and IOP eating-disorder care using internal criteria (MCG / InterQual) that don't match generally accepted standards — a pattern struck down in Wit v. United Behavioral Health (2019) and prohibited under MHPAEA. We turn APA 2023, AED Medical Care Standards, and federal parity law into a board-ready appeal.
Read guide →Endocrine (non-diabetes)
Specialty endocrine drugs are denied at the highest rates of any therapy class. Tepezza. Isturisa. Crenessity. Yorvipath. And testosterone — denied for thousands of men despite confirmed labs. We cite Endocrine Society + AACE + pivotal trials (LINC 3, HORIZON, CAHtalyst, PaTHway).
Read guide →ENT / Otolaryngology — sinus surgery, septoplasty, tonsillectomy, head & neck
AI-drafted appeal letters for denied FESS, balloon sinuplasty, septoplasty, tonsillectomy, OSA surgery (Inspire/UPPP/MMA), head & neck cancer surgery, vocal fold and otologic procedures — citing AAO-HNS Clinical Practice Guidelines, NCCN Head & Neck Cancers, AHRQ comparative effectiveness reviews, the STAR trial for HGNS, and your insurer's exact policy.
Read guide →Eosinophilic esophagitis (EoE)
Dupixent. Eohilia. Swallowed steroids. Elimination diets. Dilation. Insurers love to deny Dupixent until you've failed two swallowed steroids and an elimination diet — but ACG 2020 and AGA/JTF 2020 list these as PARALLEL options, not a forced sequence. We turn LIBERTY-EoE-TREET + Eohilia pivotal data into a board-ready appeal.
Read guide →Fertility & IVF
AI-drafted appeals citing ASRM guidelines, your state's IVF mandate, and the exact insurer policy that was used against you — ready for you or your REI to send.
Read guide →Genetic testing
AI-drafted appeals for BRCA, Lynch, hereditary cancer panels, NIPT, tumor profiling, MRD, and pharmacogenomics — citing the exact NCCN criterion, USPSTF B-recommendation, and CMS NCD that overturns your insurer's denial.
Read guide →GERD & severe reflux
Voquezna. Dexilant. LINX. TIF. Nissen. Barrett RFA. Insurers reflexively deny anything beyond cheap omeprazole — even when ACG 2022, AGA, SAGES 2021, and Lyon Consensus 2.0 support it. We turn the evidence into a board-ready appeal letter.
Read guide →Glaucoma (drops + procedures + surgery)
SLT denied as 'try drops first.' MIGS denied as 'experimental.' Vyzulta denied as 'try generic latanoprost.' Tube shunt denied as 'do trabeculectomy first.' AAO POAG PPP 2020 + EGS 5th edition + LiGHT + HORIZON + PTVT all support these. We turn pivotal trial data + FDA approval dates + AGS position papers into a board-ready appeal.
Read guide →GLP-1 weight-loss drugs
Up to 6 in 10 GLP-1 denials get overturned on appeal — but only 2 in 1,000 people try. We write the letter your doctor signs, ready in minutes.
Read guide →Growth hormone replacement therapy
Skytrofa. Sogroya. Ngenla. Norditropin. Increlex. Insurers love to call ISS 'cosmetic', demand a single ITT, label weekly GH 'experimental', or force-switch to formulary brand. The Endocrine Society 2016 guideline + AACE 2019 adult GHD update + ESPE/PES Turner 2017 + heiGHt / REAL-4 / somatrogon Phase 3 say otherwise. We turn auxology, two provocative stims, IGF-1 SDS, and pituitary MRI into a board-ready medical-necessity letter.
Read guide →Hearing aids, cochlear implants, BAHA
Medicare excludes hearing aids — but Medicare Advantage, your state mandate, EPSDT for kids, and prosthetic-device classification for BAHA and cochlear implants frequently overturn denials. We draft a citation-grade appeal letter in 90 seconds.
Read guide →Hemophilia & bleeding disorders
AI-drafted appeal letters for Hemlibra, EHL factor, Roctavian, Hemgenix, and rare bleeding disorder therapies — citing MASAC, WFH 2020, and pivotal trial data your insurer can't ignore.
Read guide →Hepatitis C cures
AASLD and IDSA say treat ALL patients with chronic HCV — no fibrosis gatekeeping, no sobriety requirements, no specialist gatekeeping. We draft your appeal using official guidance, pivotal trial data, and case law that overturns these denials.
Read guide →Hereditary angioedema (HAE)
Takhzyro. Orladeyo. Haegarda. Cinryze. Berinert. Firazyr. HAE is rare (~1 in 50,000) but life-threatening — laryngeal attacks have ~30% historical mortality untreated. We cite WAO/EAACI 2021/22, US HAEA 2020, HELP, COMPACT, APeX-2, and FDA labels to overturn 'not severe enough' / 'try IV first' / 'switching not justified' denials.
Read guide →HIV PrEP & HIV treatment
Insurers are still charging copays, requiring prior auth, and denying Apretude and Descovy — even though USPSTF Grade A + ACA §2713 require $0 cost-sharing. We draft the appeal that cites the law, the guidelines, and the pivotal trials.
Read guide →Home healthcare — home nursing, home infusion, home PT/OT/SLP, home aide, hospital-at-home
AI-drafted appeals for skilled home nursing, home infusion (IVIG, biologic, OPAT, TPN), home PT/OT/SLP, home health aide, and Hospital-at-Home denials — citing 42 CFR §484 Home Health CoP, Medicare PDGM, CMS Manual Ch 7 homebound criteria, Jimmo v Sebelius 2013, AHCAH waiver, NAHC, and INS Standards.
Read guide →Hospice / palliative — eligibility, GIP, recertification, concurrent care
AI-drafted appeal letters for denied hospice eligibility, GIP/CHC level of care, recertification, palliative consults, and pediatric concurrent care — citing CMS Hospice Conditions of Participation, the per-diagnosis LCDs from Palmetto/NGS/Noridian/WPS/CGS, NHPCO Standards, AAHPM clinical guidelines, and your insurer's exact policy.
Read guide →IBS & functional GI
Linzess. Trulance. Xifaxan retreatment. Viberzi. Motegrity. OIC PAMORAs. Gimoti for gastroparesis. Insurers default to 'try OTCs first' — even when ACG 2021, AGA 2022, and Rome IV criteria support targeted Rx therapy. We turn the evidence into a board-ready appeal letter.
Read guide →Immune globulin (IVIG/SCIG) for PIDD
Privigen. Gamunex-C. Hizentra. Cuvitru. Xembify. HyQvia. Insurers love to demand FFP first, deny CVID for 'borderline' IgG, force formulary brand swaps despite documented reactions, or refuse SCIG transitions. AAAAI/ACAAI 2015 (Bonilla), IDF guidelines, and ESID/IUIS criteria back full-dose immune reconstitution targeting trough >=700-1000 mg/dL — and Orange 2010 proved every 100 mg/dL of trough cuts pneumonia 27%.
Read guide →Inflammatory bowel disease (Crohn's + UC)
Humira. Remicade. Stelara. Skyrizi. Tremfya. Entyvio. Rinvoq. Zeposia. Velsipity. Insurers love to force step-therapy ladders that AGA 2020 and ACG don't endorse — they list TNFi, IL-23, anti-integrin, and JAKs as PARALLEL first-line targeted options for moderate-severe IBD. We turn ACCENT, ULTRA, UNIFI, ADVANCE, U-ACHIEVE, True North, ELEVATE-UC-52, and AGA TDM 2017 into board-ready appeals.
Read guide →Inpatient rehab — IRF / SNF / LTAC admission and length-of-stay
AI-drafted appeal letters for denied IRF admission, IRF length-of-stay, SNF coverage, LTAC admission, and level-of-care downgrades — citing CMS Inpatient Rehabilitation Facility regulations (42 CFR §412 Subpart P), the 60% Rule (§412.29), Medicare Benefit Policy Manual Chapters 1 & 8, the Jimmo settlement, and your insurer's exact policy.
Read guide →Interventional pain — SCS, RFA, ESI, kyphoplasty
AI-drafted appeals for SCS, DRG, RFA, ESI, kyphoplasty, and SI joint fusion denials — citing NACC, CMS NCD 160.7, MPW 2020, and your insurer's exact policy.
Read guide →Interventional radiology — UFE, PAE, TIPS, Y-90, tumor ablation, kyphoplasty
AI-drafted appeals for UFE, PAE, TIPS, Y-90, tumor ablation, kyphoplasty, and PE thrombectomy denials — citing SIR Practice Parameters, FIBROID Registry, BCLC algorithm, PRECISION-V, SHARP, REACH-2, DOORWAY, VAPOUR / VERTOS IV, and your insurer's exact policy.
Read guide →IV iron infusion
About 5 million Americans need IV iron each year. 40%+ can't tolerate oral iron — nausea, constipation, GI pain — and patients with IBD, malabsorption, HMB, or heart failure often won't respond to pills at all. Insurers still reflexively demand 'try oral iron first.' We turn ACG 2020, ACOG, KDIGO 2024, ESC 2021, ECCO 2015, and pivotal trial data into a board-ready appeal.
Read guide →Kidney disease — CKD, ESRD, IgAN, ADPKD
AI-drafted appeals for Tarpeyo, Filspari, SGLT2 inhibitors, ESAs, HIF-PHIs, transplant immunosuppressants, and dialysis access denials — citing FDA labels, KDIGO 2024 guidelines, and pivotal trials your insurer's medical director recognizes.
Read guide →Liver (non-HCV) — NASH/MASH, PBC, AIH, Wilson
Rezdiffra. Ocaliva. Iqirvo. Livdelzi. Bylvay. Livmarli. Xifaxan. The first FDA-approved MASH drug and three new PBC therapies arrived in 2024 — and insurers haven't caught up. We turn AASLD guidelines + MAESTRO-NASH + ELATIVE + RESPONSE trial data into a board-ready appeal letter.
Read guide →Long COVID / PASC
17 million Americans live with Long COVID. Insurers routinely deny multidisciplinary care, POTS treatment, LDN, and rehabilitation as 'experimental' or 'self-limiting' — despite ICD-10 recognition since 2021 and over $1.15B in NIH RECOVER funding. We turn evidence into appeals.
Read guide →Lupus & rheumatology
Benlysta. Saphnelo. Lupkynis. Cyclophosphamide. Rituximab. Insurers love to demand sequential failure of MMF, then cyclophosphamide, then a biologic — but EULAR 2023 / 2025 and KDIGO 2024 now endorse EARLY combination therapy with belimumab or a CNI on top of MMF, not sequential. We turn BLISS-LN, AURORA-1, and TULIP-2 pivotal data into a board-ready appeal.
Read guide →Lymphoma & leukemia (heme malignancies)
Brukinsa over Imbruvica. Pirtobrutinib for BTK C481S. Venclexta-G fixed-duration. A+AVD frontline HL. Lunsumio bispecific FL. Venclexta+aza unfit AML. Asciminib 1L CML. Ojjaara for anemic MF. Rytelo for transfusion-dependent MDS. Insurers love to step-therapy through 2010-era drugs — but ALPINE / ELEVATE-RR / RESONATE-2 / CLL14 / MURANO / ECHELON-1 / VIALE-A / AGILE / ASCEMBL / ASC4FIRST / SIMPLIFY-1 / COMMANDS / IMerge updated NCCN. We turn those into a board-ready letter.
Read guide →Maternity & postpartum
Pregnancy and postpartum coverage in the U.S. is a paradox — the ACA mandates breast pumps + lactation support + prenatal vaccines at zero cost; ACOG recommends NIPT for every pregnancy regardless of age; HRSA Women's Preventive Services Guidelines spell out exactly what plans must cover. And yet 1 in 4 pregnant patients gets a denial letter for something on those lists. We turn ACOG Practice Bulletins, SMFM Consults, ACIP schedules, and §2713 statutory text into a board-ready appeal.
Read guide →Melanoma & melanoma-immunotherapy
Keytruda. Opdivo+Yervoy. Opdualag. Tafinlar+Mekinist. Braftovi+Mektovi. Amtagvi. Kimmtrak. Imlygic. Insurers love to call combination ICI 'too toxic,' TIL therapy 'experimental,' or demand BRAF/MEK before checkpoint in BRAF-mutant disease — but CheckMate-067 (6.5-yr OS), DREAMseq (checkpoint-first wins), C-144-01 (Amtagvi pivotal), and IMCgp100-202 (Kimmtrak) say otherwise. We turn NCCN v3.2024 and the pivotal trials into a board-ready appeal.
Read guide →Men's sexual health — TRT + ED
Testosterone. PDE5 inhibitors. Alprostadil. Penile implants. Insurers love to deny TRT as 'lifestyle' or 'age-related,' deny brand PDE5i in favor of generics, and deny implants as 'too aggressive' — but AUA 2018 + Endocrine Society 2018 set explicit thresholds, and TRAVERSE NEJM 2023 (5246 men) refuted the cardiovascular-risk argument. We turn those guidelines + pivotal trials into a board-ready appeal.
Read guide →Mental health & behavioral health
Most behavioral-health denials reversed on external IRO review when properly argued. We draft a parity-law-backed appeal in minutes.
Read guide →Migraine CGRP inhibitors
AI-drafted appeals for Aimovig, Ajovy, Emgality, Vyepti, Qulipta, Nurtec, Ubrelvy, Botox and more — citing AHS 2024, ICHD-3, and the pivotal trials your insurer is ignoring.
Read guide →Mohs surgery & dermatologic surgery — BCC, SCC, melanoma in situ, SLNB, PDT
AI-drafted appeal letters for denied Mohs micrographic surgery, wide local excision, sentinel lymph node biopsy, photodynamic therapy, surgical reconstruction, and medically-necessary scar revision — citing the AAD/ACMS/ASDSA/ASMS Mohs Appropriate Use Criteria 2012, NCCN Skin Cancer Guidelines, AAD clinical guidelines, Brigham staging, and your insurer's exact policy.
Read guide →MS treatments
AI-drafted appeal letters for denied DMTs — Ocrevus, Kesimpta, Tysabri, HSCT, and more. Grounded in AAN 2018 guidelines, ECTRIMS/EAN consensus, and the pivotal trials your insurer is ignoring.
Read guide →Multiple myeloma (non-CAR-T)
Quadruplet induction (DVRd / IsaVRd). BCMA + GPRC5D bispecifics. Anti-CD38 SC vs IV. Revlimid maintenance. Selinexor. Tandem ASCT. Insurers love to call bispecifics 'experimental' or force step-therapy through 5 prior lines — but Tecvayli, Elrexfio, and Talvey are FDA-approved at ≥4 prior lines and category-1 in NCCN MM v3.2024. We turn MajesTEC-1, MonumenTAL-1, MAIA, GRIFFIN, IMROZ, and CALGB 100104 into a board-ready letter.
Read guide →Myasthenia gravis & CIDP
Vyvgart. Ultomiris. Soliris. Rystiggo. Zilbrysq. Hizentra-CIDP. Vyvgart-Hytrulo CIDP. Insurers love forced step-therapy through pyridostigmine, steroids, and a steroid-sparing immunosuppressant before any biologic — but IST 2020 + AAN 2021 define refractory MG as inadequate response OR intolerance to ≥1 IS, and EAN/PNS 2021 lists IVIG/steroids/PLEX as PARALLEL CIDP first-line. We turn REGAIN, ADAPT, MycarinG, RAISE, PATH, and ADHERE into a board-ready appeal.
Read guide →Neurology — Alzheimer's, Parkinson's, ALS, epilepsy
AI-drafted appeal letters for denied Alzheimer's, Parkinson's, ALS, and epilepsy treatments — citing AAN guidelines, CMS NCD 200.3 (anti-amyloid CED registry), and pivotal trial data.
Read guide →Neuropsychological & psychological testing — ADHD, TBI, dementia, ASD, presurgical eval
AI-drafted appeals for denied neuropsychological and psychological testing — ADHD, post-concussion, dementia, ASD, presurgical (epilepsy / DBS / bariatric), and learning disability evaluations. We cite the NAN 2019 Medical Necessity Position Paper, AACN Practice Guidelines, APA Specialty Guidelines, INS Standards, and your insurer's exact policy.
Read guide →Neurosurgery — discectomy, laminectomy, craniotomy, shunt
AI-drafted appeal letters for denied discectomy, fusion, ACDF, CADR, craniotomy, shunt, and Chiari decompression — citing NASS Coverage Recommendations, AANS/CNS Joint Guidelines, NEJM SPORT trial, IDE pivotal trials (Mobi-C, Prestige), AHA/ASA aneurysm guidelines, and your insurer's exact policy.
Read guide →Orthopedics & sports medicine
TKA. THA. ACL. Rotator cuff. MACI cartilage. PRP. Mako robotic. Cervical ADR. Insurers default to BMI / age / 'experimental' denials that ignore AAOS, AOSSM, NASS guidelines + AJRR registry data + pivotal trials. We turn that evidence into a board-ready appeal letter.
Read guide →Osteoporosis
Prolia. Evenity. Forteo. Tymlos. Reclast. Insurers deny anabolics, denosumab, and DEXA scans every day — even when AACE 2020/2024, ACP 2023, and Endocrine Society 2019/2020 guidelines support treatment. We turn FREEDOM, ARCH, FRAME, HORIZON, ACTIVE, and VERO trial data into a board-ready appeal letter.
Read guide →Out-of-network emergency
Federal law (the No Surprises Act, effective Jan 2022) protects you from surprise bills for emergency care, air ambulance, and OON specialists at in-network hospitals. We draft a statute-cited appeal in under 10 minutes.
Read guide →Pediatric epilepsy
Epidiolex. Fintepla. Diacomit. Ztalmy. ACTH for infantile spasms. Sabril for TSC. VNS. Epilepsy surgery. Insurers love to deny pediatric epilepsy drugs as 'experimental' or push prednisolone over ACTH on cost — but AES 2010 + 2024 list ACTH as first-line for IS, and Epidiolex/Fintepla/Diacomit/Ztalmy are FDA-approved with NEJM- and Lancet-grade pivotal trials. We turn GWPCARE + Study 1502/1601 + STICLO + Marigold into a board-ready appeal.
Read guide →Pediatric oncology
Pediatric oncology denials hit the hardest cases — CAR-T, proton therapy, out-of-state COG center care, off-label precision medicine, fertility preservation. We turn COG protocols, NCCN AYA guidelines, ASTRO Proton Therapy Model Policies, and pivotal trial data (ELIANA, ANBL0532, AALL0232, SPRINT) into a structured appeal letter you can send today.
Read guide →Pediatric subspecialty — cardiology, GI, pulmonology, rheumatology, endocrinology, neurology
AI-drafted appeal letters for denied pediatric cardiology, GI, pulmonology, rheumatology, endocrinology, and neurology services. We cite the AAP, AHA/AAP Kawasaki guideline, NASPGHAN, ATS/ERS, ACR pediatric JIA + lupus criteria, Pediatric Endocrine Society, and your insurer's exact policy.
Read guide →Pediatric therapy
AI-drafted appeal letters for ABA, speech, OT, PT, feeding, and vision therapy denials. We cite your state's autism mandate, EPSDT, MHPAEA, and the CASP and ASHA clinical guidelines insurers don't want you to know about.
Read guide →Plaque psoriasis + psoriatic arthritis
Skyrizi. Tremfya. Cosentyx. Taltz. Bimzelx. Sotyktu. Humira. Stelara. Rinvoq. Otezla. Vtama. Zoryve. Insurers love forced TNFi step-therapy and BSA-percentage gatekeeping — but AAD-NPF 2019, ACR/NPF 2018 PsA, and GRAPPA 2021 endorse parallel biologic options after topical/phototherapy, with special-site involvement (face/genital/scalp/palms/soles/nails) bypassing BSA cutoffs entirely. We turn UltIMMa, ERASURE/FIXTURE, BE READY, KEEPsAKE, DISCOVER, SPIRIT, and POETYK data into a board-ready appeal.
Read guide →Prostate cancer
Pluvicto. ARSI. PARPi. Provenge. PSMA-PET. Insurers love to force generic ADT before ARSI in mHSPC, demand multiple chemo lines before Pluvicto, or restrict PARPi to BRCA-only — but STAMPEDE/LATITUDE/TITAN/ARASENS, VISION/PSMAfore, PROfound/TALAPRO-2, and the Mar 2025 Pluvicto label expansion say otherwise. We turn NCCN v1.2025 + AUA 2023 + EAU 2024 + the pivotal NEJM/Lancet trials into a board-ready appeal.
Read guide →Pulmonary hypertension
Winrevair. Opsumit. Adempas. Uptravi. Tyvaso. Insurers love to force step-therapy through PDE5 + ERA before adding a prostacyclin or sotatercept — but ESC/ERS 2022 RECOMMENDS upfront double therapy for low/intermediate risk and upfront triple (incl. parenteral prostacyclin) for high-risk patients. We turn AMBITION + GRIPHON + INCREASE + STELLAR into a board-ready appeal.
Read guide →Radiation oncology — proton, SBRT, brachytherapy, IMRT, IORT
AI-drafted appeals for proton, SBRT, brachytherapy, IMRT escalation, IORT, and MRI-LINAC denials — citing ASTRO Clinical Practice Guidelines, ASTRO Model Policy on PBT (2024), NCCN, ABS, AAPM, PACE-B, HYPO-RT-PC, PARTIQoL, Bekelman 2022, and your insurer's exact policy.
Read guide →Rare disease — ERT, substrate reduction, gene therapy
AI-drafted appeal letters for Pompe, Fabry, Gaucher, MPS, Batten, NPC, PKU and other rare disease therapies. Cites Orphan Drug Act, FDA approval, disease registries, and your specific insurer's medical policy in minutes.
Read guide →Reconstructive plastic surgery — lymphedema, panniculectomy, burn, Mohs, hand
AI-drafted appeal letters for denied lymphedema surgery (VLNT/LVA/LYMPHA), panniculectomy, burn reconstruction, Mohs reconstruction, and hand reconstruction — citing ASPS Practice Parameters, ASRM, ISL 2020 staging, Boyages liposuction trial, Becker LNT data, Cohen panniculectomy criteria, and your insurer's exact policy.
Read guide →Severe acne
Accutane. Seysara. Aklief. Winlevi. Absorica LD. Spironolactone. Insurers default to step-therapy that ignores AAD 2024 — even when scarring + recalcitrant disease justify first-line isotretinoin. We turn AAD 2024 + Global Alliance + iPledge REMS + pivotal trials (PERFECT, ACME, CB-03-01) into a board-ready appeal letter.
Read guide →Sickle cell & thalassemia
AI-drafted appeals built on ASH 2020 SCD Guidelines, TIF Thalassemia standards, FDA labels, and the new CMS Cell & Gene Therapy Access Model — so insurers and state Medicaid agencies can't hide behind outdated policies.
Read guide →Sleep medicine — CPAP, BiPAP, ASV, oral appliances, Inspire HNS
AI-drafted appeals for denied CPAP, BiPAP, ASV, custom oral appliances, Inspire / Genio hypoglossal stimulation, eXciteOSA, sleep studies, and narcolepsy medications — grounded in CMS LCD L33718 + L38276, AASM/AADSM guidelines, and the exact policy your insurer cited.
Read guide →Solid-organ transplant
Tacrolimus formulation switches. Belatacept. mTOR conversion. AMR rescue. CMV prophylaxis. Desensitization. Insurers love to substitute generic NTI tacrolimus, force CNI failure before belatacept, or call rituximab+IVIG+TPE 'experimental.' KDIGO, ISHLT, AASLD, ATS, ASN, and Banff 2022 disagree — and so do we.
Read guide →Specialty biologics
Specialty biologics cost $50k–$120k+ per year. We draft a physician-grade appeal using ACR, AAD, AGA, and GINA guidelines plus the head-to-head trial data your insurer's own medical policy already cites.
Read guide →Spinal muscular atrophy
Spinraza. Evrysdi. Zolgensma. Three FDA-approved disease-modifying therapies — and three drugs payers love to step-therapy, age-cap, or call 'experimental in combination.' SMA Standards of Care 2018 (Mercuri/Finkel) endorse all three with patient-specific selection. We turn ENDEAR / CHERISH / NURTURE / STR1VE / SPR1NT / SUNFISH / FIREFISH / JEWELFISH / RAINBOWFISH into a board-ready appeal.
Read guide →Stroke & neuro rehab
800,000 Americans have a stroke each year. Insurers say you're 'out of the tPA window' — when DAWN and DEFUSE-3 extended thrombectomy to 24 hours. They deny IRF admission and shove you into SNF — when stroke is qualifying under Medicare's 60% Rule. They cap outpatient PT at 20 visits — when Congress repealed the Medicare therapy cap in 2018. They call Lokomat 'experimental' — when LEAPS published in NEJM 2011. They cover Botox for your arm but deny your leg — when FDA approved lower-limb spasticity in 2016. We turn AHA/ASA 2016 + 30+ pivotal NEJM/JAMA/Lancet trials into a board-ready appeal.
Read guide →Substance use disorder treatment (SUD/MOUD)
AI-drafted appeal letters for substance use disorder denials — MOUD, residential, detox, Sublocade. Built on ASAM Criteria 4th Edition, MHPAEA 2024 NQTL rule, and the 2023 X-waiver removal. Insurers cannot demand abstinence-only or specialist-only care.
Read guide →Surgery denied as 'not medically necessary'
AI-drafted appeal letters citing the exact ASMBS, NASS, WPATH SOC8, ACOG, and WHCRA guidelines your insurer's own policy is supposed to follow.
Read guide →Thyroid eye disease (TED) — Tepezza (teprotumumab) and IGF-1R therapy
AI-drafted appeals for Tepezza (teprotumumab), orbital decompression, IV steroids, and other TED therapy denials — citing AAO PPP 2022, Bartalena International Consensus, the OPTIC and Phase 2 trials (Smith NEJM 2017, Douglas NEJM 2020), and your insurer's exact policy.
Read guide →Treatment-resistant depression — rTMS, Spravato, ECT
TRD by definition is failure of pharmacotherapy. Insurers love to demand 4 antidepressant failures, label SAINT 'experimental', call ECT 'last-resort', or block Spravato as step-therapy after ECT — but APA TRD 2022, FDA-cleared device labels, and the actual pivotal trials say otherwise. We turn STAR*D, SAINT, TBS-D, TRANSFORM, ASCERTAIN, and INTREPID into a board-ready appeal.
Read guide →Vascular & endovascular — AAA, carotid, PAD, varicose veins, IVC filters
AI-drafted appeals for EVAR, CEA / CAS / TCAR, PAD revascularization, varicose vein ablation, IVC filter, and DVT thrombolysis denials — citing SVS Clinical Practice Guidelines, ACC/AHA, CREST, ICSS, EVA-3S, ATTRACT, CaVenT, and your insurer's exact policy.
Read guide →Vision & retinal — anti-VEGF, GA, gene therapy
From Eylea HD step-therapy denials to Syfovre 'experimental' rejections to Luxturna gene therapy gatekeeping — citing AAO Preferred Practice Patterns, ARVO position on Avastin equivalence, CMS NCDs, and pivotal trials (CATT, TENAYA, DERBY, GATHER).
Read guide →Women's health — menopause, endometriosis, PCOS, PPD
Veozah. Zurzuvae. Orilissa. Myfembree. Mirabegron. Botox for OAB. The first non-hormonal hot-flash drug, the first oral PPD drug, GnRH-antagonist combos for endometriosis — insurers default to step-therapy that wasn't designed for these new options. We turn ACOG, NAMS, and pivotal-trial data into a board-ready appeal.
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