Read the denial.
Win the appeal.

UnitedHealthcare denied our client hospital's claim for a 4-day inpatient cardiac admission as 'not medically necessary,' downgrading it to observation and citing MCG care guidelines. The patient had chest pain, elevated troponins, and a positive stress test. The plan is ERISA self-funded; we're at internal appeal with the deadline in 12 days. Build the appeal to overturn the denial.

Aetna denied prior authorization for proton beam therapy for our client's pediatric CNS tumor patient as 'experimental and investigational,' citing its clinical policy bulletin. Build the appeal packet to overturn the denial and preserve external-review rights.