Your denied healthcare claims, handled. Introducing Claimable's AI-powered platform that helps patients challenge unjust denials with custom appeal in minutes.

At Claimable, we believe everyone is entitled to the care they need and coverage they deserve. Our physician-led team of healthcare insiders, data scientists and technologists is dedicated to fighting back against the 850 million denied U.S. health claims each year, challenging baseless denials and removing barriers to care, financial strain, and medical debt.

Introducing Claimable's AI-Powered Platform

Our AI-powered platform analyzes clinical research, policy details, appeals data and your unique medical story to generate and submit customized appeals in minutes.

"This platform is a lifeline for those caught in the machinery of an industry that too often prioritizes dollars over lives."
–Wendell Potter, health insurance reform expert and former insurance executive

Using Claimable is like having your very own team of AI-powered experts:

Analyzer

We extract relevant details from your documents and plan policies so you don’t have to, and transform them into compelling facts and powerful stories.

Researcher

We instantly search millions of clinical guidelines, appeal precedents, policy details and legal frameworks to find evidence that supports your claim.

Strategist

We gather, review, and apply learnings from winning appeals similar to yours, ensuring you have the strongest strategy possible.

Wordsmith

We create your appeal in minutes, using our proprietary algorithm to maximize the strength of arguments, evidence, tone, voice and style.

Assistant

We help you reach the right decision-makers by taking care of letter delivery and tracking, and offer guides, reminders and tips for following up.  

Breaking down your winning appeal

Claimable is your secret weapon, blending advanced technology, insider knowledge, and a library of evidence to craft customized appeals that get results. 

We pull information from three important categories to craft a comprehensive, compelling appeal.

Personal Impact

Your story matters. We summarize facts, events and the personal impact of denied care on your health, life and finances. 

Clinical Evidence

We illustrate the clinical justification for care, pulling from medical studies, established guidelines, claims and appeals precedents.

Policy Compliance

We include plan policies and local laws relevant to your case, demanding insurers provide specific decision details and a fair, fast appeal review.

Getting started

Our appeal builder makes the process painless, we promise. Here's what to expect:

• Eligibility check - While we are working hard to support all types of care and conditions, we currently support autoimmune and migraine related denials within the last 180 days. As a first step, we will review your denial details and let you know If Claimable can help.
• Easy document upload - You’ll start by snapping a photo of your insurance information and denial notice. This helps us save you time and ensures we don’t miss anything. No documents, no problem – you can share details manually.
• Medical history questionnaire - We'll ask you a few simple questions about the events leading up to the denial. To prepare, be ready to share what alternative treatments you’ve tried in the past and why your doctor prescribed the treatment. 
• Optional extras - In some cases, sharing a statement of medical necessity from your doctor or other documentation may strengthen or expedite your case. These aren’t required, and we’ll explain how to obtain extras if you don’t have them.

You can pick up where you left off anytime and your information will be saved.

Getting a fast and fair response

Once your appeal is created, we don’t stop there. We send your appeal by Fax and First Class Mail with tracking to make sure it’s received.  We request urgent, 72-hour reviews when appropriate, and typically receive standard appeal decisions within a couple weeks. In addition, we hold insurers accountable to Affordable Care Act and ERISA regulations that mandate who reviews your appeal, what they share about their decision, when they share it and how they share it.

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Support when you need it

We provide guidance, reminders and tips to help you take action with confidence, and offer expert support when you need it.

• Reminders and tips - Throughout the process, we offer step-by-step guidance to capture your personal story, review your draft appeal, reach the right decision-makers and follow up with insurers.
• Knowledge resources - Get answers for commonly asked questions, understand your appeal rights and process, and decode confusing terms and codes.
• Support when you need it -  Our appeals team is available when you have questions, want clarifications or need extra support. We respond to support needs within 1-3 business days via email and offer live support when needed.

Getting it all at a fair, flat and affordable price

We don’t take percentage-based fees because we believe getting access to the care you need and coverage you deserve shouldn’t cost you a fortune. Instead, Claimable’s AI-powered platform delivers a powerful, efficient, affordable appeals, without having to pay thousands for a lawyer or professional advocate.

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In this article, we'll help you understand the role of your doctor when appealing a denied healthcare claim, and learn how best to work together–including 7 types of information to share.

If you find yourself confused and frustrated by insurance claims and denials, you are not alone. I’m a doctor and a patient with a chronic condition. I even worked at an insurance company for a while. With all that experience under my belt, I still find the rules and processes illogical and infuriating. 

The most important thing to know is that you can appeal.
It’s your right!

In this article, we’re going to talk about the role of your doctor when appealing a denial, and how best to work together––including my top 7 topics to discuss. 

Do I need to involve my doctor in my appeal? 

You do not need your doctor’s involvement to appeal a denied healthcare claim. There’s no set playbook and it’s unlikely your doctor is an expert (they don’t teach these things in medical school). If and how you involve your doctor is a personal choice.

It’s important to know that appealing directly can be very effective. Many doctors don’t know this is an option, and don’t advise their patients to appeal as a result. . 

So what can your doctor do? 

Unsurprisingly, there isn’t one simple path for your doctor to take. If your doctor's office has a lot of support staff, they may call the insurer for you and try to iron out the problem. The insurer may have your doctor speak to one of their doctors. This is something called a peer-to-peer review (though these calls can be tough to coordinate with limited peer availability for certain specialties). 

Instead, your doctor might suggest you try another treatment or enroll in a Patient Assistance Program. 

Discuss the trade-offs of different treatment options in terms of benefits, risks, time and costs.

7 denial topics to discuss with your doctor

The insurer might need more information to determine if the drug is appropriate or cost-effective. Below is a list of 7 items to arm your doctor with:

#1 - Symptoms

Track the frequency and severity, and share your notes with your doctor. It’s helpful to have everything formally documented in your medical records. 

#2 - Impact

Explain the impact on your daily life if care is denied. For example, an inability to drive, perform your job as expected, or care for a loved one.

#3 - History

Many insurers have specific rules around what has to be tried before they will pay for certain medications. Make sure your doctor documents all other medications and treatments you’ve previously tried, and why they did not work for you. 

#4 - Denial Reason

If you get a letter from the insurer, it might include a term like “denied for medical necessity,” “treatment is deemed experimental,” or “excluded benefit.” Or, perhaps you’ve concluded a trial period and need to report results to renew your medication. Knowing the reason for the denial allows your doctor to focus their conversation on the right issue. 

#5 - Current Guidelines

Ask your doctor to double-check current guidelines and to document against them as much as possible. These are often the basis of the insurance company rules. 

#6 - You Rights

You might need to tell your doctor that under the Affordable Care Act, your right to appeal is protected. An insurer must give you a good-faith reason as to why they denied your care.  

#7 - Urgent Review

If your medical needs are urgent because you face severe harm to your physical health, you may qualify for the Insurer to review your case more rapidly - usually within 72 hours. Make sure your doctor is aware of this, if applicable.

Arming your doctor with these 7 types of information will help them advocate more effectively on your behalf.

If you’re appealing directly, your doctor can still help. 

Getting a letter from your doctor stating the medical necessity and urgency of your care could help your case. This “Letter of Medical Necessity” doesn’t have to be long, but should include the condition that’s being treated, the treatment required, the reason it’s needed, and what happens if it isn’t received. It should be signed, dated, and included in your appeal. 

Certain insurers may ask for seemingly random information from your doctor, such as the Tax ID number of the practice. In this case, reach out to your doctor and explain why you need this information. Your doctor wants you to get the care you need, and should gladly empower you to file an appeal. 

I don’t know how to appeal. Where do I begin? 

Appealing a denied healthcare claim can feel overwhelming, but don’t worry, Claimable makes it painless. Our AI-powered platform analyzes clinical research, policy details, appeals data, and your personal medical story to generate and submit customized appeals in minutes. Our Introducing, Claimable article has everything you need to know to get started. The same details you might provide to your doctor can serve as the basis for an impactful direct appeal.

Ultimately, the best advocate for your health is you.

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Learn why your health insurance claim file is essential for appealing denied claims, how to request it, and what to look for when reviewing it to strengthen your case.

What is a Claim File?

A claim file contains all the documents and communications your health plan used to decide whether to approve or deny your claim. Most health plans are legally required to share this information. According to a ProPublica investigation, reviewing your claim file can help expose mistakes or misconduct by your health plan, which can make your future appeals stronger.

When Should I Request My Claim File?

You can request your claim file anytime after a denial, but we recommend doing so if your first appeal is unsuccessful. This way, you can avoid delays or extra paperwork that might interfere with a timely reconsideration. It's a smart move to have this information in hand if you need to take further steps.

Why are Claim Files Important?

Your claim file gives you insights into why your claim was denied and may reveal errors or inconsistencies that can help you in your next appeal.

Most health plans are required to provide your claim file within 30 days, so you can review it carefully.

How to Request Your Claim File

1. Request Your Claim File
   If you appealed through Claimable, don’t worry—we’ve already requested it as part of your appeal process. If not, you can use ProPublica's handy template to request it yourself.
2. Call to Follow Up
   Call your insurance company’s member services team (the number’s on your insurance card) to make sure they’re processing your request. It never hurts to check in!
3. File a Complaint
   If your insurer doesn’t provide your claim file within 30 days, it’s time to file a complaint with your state or federal regulatory agency. You’re entitled to this information.

How do I review my claim file?

Reviewing your claim file might seem daunting, but with the right checklist, you can spot important details.

Look for any missing documents or internal communications that could reveal mistakes or issues with how your claim was handled.

And remember—you can always share your claim file securely with us at Claimable if you want to participate in our ongoing research on denial issues. Just reach out at support@getclaimable.com, and we’ll send you a secure link.

Claim File Checklist

Here’s what you should look for when reviewing your file:

Does it cover the right time frame?

It should include documents leading up to, during and after your denial. If documents provided do not cover the time period stated in your claim file request–it’s incomplete.

Does it include call recordings, transcripts and call logs?

The file should contain all phone call recordings, transcripts and/or summary logs related to communications about your claims and/or denials. If you know you or your health provider called the health plan and don’t see it in the log–it’s incomplete. 

Does it include email communications?

It should include emails relevant to the denial(s), including internal messages and communications with healthcare providers. If you know you or your health provider emailed the health plan and don’t see it in the file–it’s incomplete.

Does it include internal messages?

The file should include internal communications among health plan staff about the evaluation or discussion of the denial(s). If the internal reasons or evidence differ from the denial notice, you may have strong grounds to challenge the decision.

Does it include claim approval and/or denial letters?

The file should include all formal and informal notices sent to you or your healthcare provider, such as denial letters or explanation of benefits. If the denial reasons change, you may have strong grounds to challenge the decision.

Does it include prior authorization requests and responses?

The file should include documents related to requests for authorization and their subsequent approvals or denials. If it includes medical records that were subsequently re-requested or ignored, you may have strong grounds to challenge the decision.

Does it include internal memos or reports?

The file should include any written reports or memoranda related to the denial(s) that were sent by or received from health plan staff. Look for any inconsistencies between these communications and your denial.

Final Thoughts

Your claim file is a powerful tool—it can give you the information you need to fight back and strengthen your appeal. We know dealing with denials can be frustrating, but Claimable is here to help. Don't hesitate to reach out if you have questions or need guidance.

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