In one paragraph
AppealHaven is a document-preparation and information tool. It is not a law firm, insurer or medical provider, does not give legal or medical advice, and is not a substitute for the advice of a lawyer. You decide what to send and you send it.
1. Not legal advice
- AppealHaven is not a law firm, and no lawyer reviews your case. Using it does not create a lawyer-client relationship.
- We are not your authorized representative. We do not act for you, and we do not contact your plan or your providers.
- AppealHaven is not a substitute for the advice of a lawyer.
- What we say about laws and rules is general information about how they usually work. It is not advice about your situation.
You may want a lawyer if your case may go to court, for example a lawsuit under ERISA after a self-funded employer plan's appeals are done. Legal aid offices help people with low incomes for free: lawhelp.org.
2. Not medical advice
- AppealHaven is not a medical provider. We do not diagnose, and we do not recommend or rate treatments.
- Only your doctor or other clinician can say a treatment is medically necessary. We draft a request for your doctor's letter; your doctor decides what it says.
If this is an emergency
Call 911. If waiting for a decision could seriously harm your health, call your plan to ask for an urgent (expedited) review, and talk to your doctor.
3. No promised outcome
Your health plan, or an independent reviewer, decides your appeal. A provider decides whether to change a bill. We do not promise or predict that any appeal, review or dispute will succeed, or that any bill will be lowered.
Figures on our site come from public sources, with links. They describe large groups of people and say nothing about your case. We do not publish figures about how our own users' appeals turn out.
4. How we work out deadlines
- We compute deadlines from published federal rules and the date printed on your letter. We show the rule we used, with a link to it.
- Your plan documents may give you more time. For fully insured plans, state law can also add rights. We may not know about either.
- If your letter or plan documents give a different date, check it with your plan. If you are not sure, aim for the earlier date.
- If a deadline falls on a weekend or a federal holiday, we tell you to send by the business day before.
[legal review: responsibility for deadline errors]
5. How we read your documents
Software, including AI models, reads your documents and drafts text. It can misread a number, miss a detail or get something wrong. We show you everything we read. Please check every detail and every sentence before you rely on it or send it.
6. The bill audit
A flagged line is something worth asking about, not proof that a charge is wrong. The provider or your plan may have a reason for it. A dispute letter asks for an explanation or a correction; it does not settle the question.
Our No Surprises Act checks follow the federal rules. Some states give more protection. Your rights, from CMS
7. Insurer details and links
Where-to-send details for UnitedHealthcare, Aetna and Cigna come from those insurers' public pages and can change. If they differ from the instructions in your own letter, follow your letter. Links to government sites and free-help programs are for your convenience; we do not control those sites.
8. Free help exists
You do not need AppealHaven to appeal. You can appeal on your own, and free help is available:
- Employer and marketplace plans: the Consumer Assistance Program, in the many states that run one
- Medicare: SHIP counselors and 1-800-MEDICARE
- Medicaid: your state Medicaid office, and legal aid
- Surprise medical bills: the No Surprises Act help line, 1-800-985-3059
9. Contact
Questions about these disclaimers: contact@optimumtechfusion.com.