Expert Appeals, Peace of Mind.

Navigating Medicare appeals can be daunting. We are your expert partners for time sensitive in-facility appeals made to Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO)

We will help you quickly craft a compelling, customized appeal to justify medical necessity and challenge care denials

You Have The Right to Appeal Medicare Denial of Medical Care Decisions

Your Right to Appeal

1
If you’re getting Medicare services from a hospital, skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice, and you think your Medicare‑covered services are ending too soon (or that you’re being discharged too soon), you can ask for a fast appeal.

2
With a fast appeal, an independent reviewer, called a Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO), will decide if your covered services should continue.

3
By appealing, you or your family member may be able to stay in the hospital (coinsurance and deductible may apply) while the BFCC-QIO reviews your case. Importantly, The hospital can't force you to leave before the BFCC-QIO reaches a decision.

4
While most appeals are denied, we have found that those few extra days that an appeal can give can be very valuable for family members to prepare, and also gain peace of mind of having given it the best shot. This sentiment was true for us and why we started this service.

Additional information about the appeal process is available on the medicare website

Our Story: Turning Personal Experience into Empowerment

A Sudden Challenge
Our journey began with a personal encounter with Medicare denial. A family member, making promising progress in Acute Rehab after a stroke, faced an unexpected setback - a notice of planned discharge. Caught between the desire for the best healthcare and the reality of out-of-pocket costs, we found ourselves at a crossroads.

Finding a Solution
Determined to advocate for our loved one, we dived into Medicare bylaws. After extensive research, we crafted a robust appeal backed by comprehensive medical literature. Our efforts paid off. We secured a few extra days of crucial care at no cost to us. This extension not only gave us precious extra time to prepare for the transition (logistics like beds, transportation, etc are not simple) but also gave us peace of mind. We were relieved that we had done everything we could possibly do. No regrets meant better mental health and an ability to move on and focus on the next steps in the recovery journey.

A Common Struggle
Through this process, we discovered we weren't alone. Hundreds of caregivers face similar challenges daily, often without the resources or knowledge to navigate the complex appeals system.

Our Mission
Inspired by our experience, we made it our mission to support others in similar situations. We're committed to building the most effective and economical solution to assist patients and caregivers in appealing Medicare care denials*.

* To ensure maximum impact, we are in the process of transitioning to a non-profit. Please feel free to contact us if you would like to help

Our Approach
Precision & Personalization - Human Expertise, AI-Enhanced

We are human-led and AI-assisted, combining the best of both worlds to craft tailored, personalized appeals. Our approach leverages professional expertise, appeals know-how, and a growing database, enhanced by cutting-edge AI technology.

Our 4-step process ensures that every case receives the highest level of care and precision:

Thorough Review of Your Case: Our human experts analyze the specifics of your situation, identifying key elements to support your appeal.
Comprehensive Research of Relevant Medical Literature: We conduct in-depth research, aided by AI, to gather necessary evidence and guidelines that substantiate medical necessity.
Clear Articulation of Medical Necessity: Our team translates complex medical information into clear, compelling language, optimized by AI for effectiveness.
Customized Drafting of Your Appeal Letter: Finally, we craft a personalized appeal letter, combining human insight with AI-enhanced precision to present your case in the strongest possible light.

This unique blend of human expertise and AI assistance ensures that your appeal benefits from both empathetic understanding and data-driven accuracy. Our goal is to ensure your voice is heard and your medical needs are clearly communicated in the appeals process.

Learn more

Acute Rehab

We are currently open to test users for our alpha product at no cost. We have a trained AI model and a powerful template. We are looking for partners to help refine and develop our solution. Please contact us for more details.