A denied health claim is the start of an appeal, not the end.
When coverage is denied, a surprise bill lands, or a treatment is ruled 'not medically necessary', Koala reads the denial, finds the basis to appeal, and drafts the letter that asks the plan to reconsider.
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What you're up against
Health denials arrive in the language of plan documents and billing codes, and the appeal window is short. Many denials are reversed on internal appeal, but only if someone answers the stated reason with the plan's own terms and your right to review.
Backup that does the work.
Reads the denial
Koala parses the reason code and the plan language behind it, and explains what's actually being disputed.
Finds the basis to appeal
It looks to your plan's terms, medical-necessity standards, and your internal and external review rights.
Drafts your appeal
You get an appeal letter that answers the denial on its own terms, before the deadline and before you send it.
Health questions
The things worth knowing before you answer your insurer.
Where do I even find out I was denied?
On the explanation of benefits: the statement the plan sends after a claim showing what was billed, what it allowed, what it paid, and what it says you owe. It is not a bill, it is the document people throw away, and the reason code on it is the exact thing an appeal has to answer.
How long do I have to appeal?
Short, and shorter than you think. The window is set by your plan and the applicable rules, and it starts running from the denial, not from the day you notice it. Find the deadline on the denial notice before you do anything else.
They said the treatment wasn't medically necessary. My doctor disagrees.
That disagreement is the appeal. A medical-necessity denial is a decision made on paper by someone who has not examined you, and it is appealable: internally to the plan first, and in most states then to an independent external reviewer who does not work for the plan.
What about a surprise bill from someone I never chose?
Out-of-network charges from a provider you had no realistic way to select (an anaesthetist, a radiologist, an emergency doctor) are exactly the situation federal and state protections were written for. A bill arriving is not the same as a bill being owed.
Don't recognise a word in your letter? Look it up in the glossary to find every term, and where it costs you money.
What health coverage actually promises.
Half of what makes a settlement arguable is knowing what the policy said it would do in the first place: what it covers, what moves the price, and what Koala can't see.
Before you reply to them, read this.
Everything below is free and requires no account. A claim answered from a position of knowing how the process works is a different claim.
- Read it
Reference
The glossary
Actual cash value, proof of loss, the appraisal clause: what each term means and where it bites.
- Read it
Guides
Playbooks for a live claim
Documenting damage before you file, and checking a total-loss valuation line by line.
- Read it
How it works
What Koala actually does
The six stages, what you approve, and what leaves your hands, all before you hand it anything.
See what you're actually owed.
Upload your documents and Koala gets to work. You approve everything before it's sent to your insurer.