Appeal an insurance denial
A denied claim is rarely the last word. You have federal and state rights to appeal, and most denials never get challenged. Bursify reads your denial and your plan, drafts the appeal citing the right rule, and sends it, you review and sign. Bursify is a self-help tool, not an insurance company or public adjuster; you file as the member.
Your federal appeal rights
Internal appeal, then external review
Under the Affordable Care Act, you have the right to a full internal appeal of any denial, and if it is upheld, to an independent external review by a reviewer who does not work for your insurer. The external decision is binding on the plan.
No Surprises Act
For most emergency care and out-of-network charges at in-network facilities, you cannot be balance-billed beyond your in-network cost-share. Disputes between the provider and insurer go to independent dispute resolution, not to you.
ERISA (employer plans)
If your coverage is through an employer, you generally have 180 days to appeal an adverse benefit determination and a right to a full and fair review, including the documents and reasoning behind the denial.
Denials we appeal
The reason code on your denial decides the argument. These are the ones we see most.
- Medical necessity
Insurer says the care was not necessary. The appeal answers with your records and the plan’s own clinical criteria.
- Out-of-network
Charged out-of-network for care you could not choose. The No Surprises Act and network-adequacy rules often apply.
- Prior authorization
Denied for a missing or late authorization. Many of these are reversible on appeal with the right documentation.
- Experimental / investigational
Care labeled experimental. The appeal cites the evidence and the plan’s coverage policy.
- Coding or billing error
A wrong code drove the denial. Correcting it and resubmitting is frequently enough.
External review by state
Live now in 10 states (CA, NY, TX, FL, GA, NC, IL, PA, OH, MI).
After an internal appeal, every state offers an independent external review. The deadlines and the agency differ by state, here is where to start.
Don't appeal it alone
Bursify reads your denial and your plan documents, drafts an appeal that cites the rule the insurer has to answer to, and sends it for you by HIPAA-compliant fax or certified mail. If they uphold the denial, we prepare the external-review request for you to review and sign. You stay the member of record on every filing.