How do insurance denial appeals work?

Upload your denial letter and Lysco analyzes it, identifies the denial reason, cites applicable laws (ACA, ERISA, state regulations), and generates a customized appeal letter. You review and submit it yourself.

What is the success rate for insurance appeals?

It varies by plan type. For ACA marketplace plans, about 44% of appealed denials are overturned (KFF, 2023). For Medicare Advantage, it can be as high as 83% (HHS OIG). Many denials stem from billing or administrative errors that get fixed when challenged. Individual results vary.

Is Lysco a law firm or medical practice?

No. Lysco is an informational tool that helps you understand your rights and options. It is not a law firm, medical practice, or insurance company. For specific legal or medical situations, consult a licensed professional.

How much does Lysco cost?

Analysis is always free and your first appeal letter is free too. Upgrade to Pro ($29/mo) or Annual ($199/year) for unlimited appeal letters, insurer playbooks, and benefits finder. Cancel anytime.

Is my health data secure on Lysco?

Yes. Lysco uses AES-256 encryption at rest, TLS for data in transit, and row-level security so only you can access your data. We never sell your data and follow HIPAA-aligned security practices.

Orthopedic Surgery Denial

Anthem / Elevance Denied Your Knee Replacement?

Anthem Blue Cross Blue Shield (Elevance Health) denies 15.3% of claims on average. But 54% of appeals succeed when patients fight back. Your knee replacement denial may have grounds for a successful appeal.

Analyze Your Denial Free Read the Appeal Guide

15.3%

Denial Rate

54%

Appeal Success

30-60 days

Typical Timeline

$30,000–$50,000

Typical Claim

Why Anthem / Elevance Denies Knee Replacement

Not medically necessary — conservative treatment not exhausted

Prior authorization not obtained

BMI requirements not met per insurer guidelines

Anthem / Elevance's Common Denial Tactics

Referencing outdated clinical criteria

Bundling denials across multiple related claims

Claiming services are "not medically necessary" without specific reasoning

How to Win Your Knee Replacement Appeal

Documentation of failed conservative treatments (PT, injections, bracing)

Radiology showing bone-on-bone or severe joint degeneration

Letter of medical necessity from treating orthopedic surgeon

Functional limitation documentation (inability to work, walk, climb stairs)

Laws That Protect You

ACA §2719 — Right to internal and external appeal

ERISA §503 — Right to a full and fair review

State parity laws for surgical coverage

Tips for Appealing to Anthem / Elevance

Demand the specific clinical policy bulletin used for the denial

Check if your state mandates coverage for the denied service

File an external review — Anthem has a 54% overturn rate on appeal

Ready to Fight Your Knee Replacement Denial?

Upload your denial letter and get an AI-powered analysis in minutes. We'll identify the weaknesses in Anthem / Elevance's reasoning and build your appeal strategy.

Analyze My Denial Free

Analysis is always free. No credit card required.

This information is for educational and informational purposes only. It does not constitute legal or medical advice. Statistics cited are from publicly available sources including KFF, HHS OIG, and state insurance department data. Individual results may vary. Consult a qualified professional before taking action on your specific situation.