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, deeper insurer-tailored analysis, 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

Molina Healthcare Denied Your Knee Replacement?

Molina Healthcare Inc. denies 21% of claims on average. But 42% 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

21%

Denial Rate

42%

Appeal Success

30-45 days

Typical Timeline

$30,000–$50,000

Typical Claim

Why Molina Healthcare Denies Knee Replacement

Not medically necessary — conservative treatment not exhausted

Prior authorization not obtained

BMI requirements not met per insurer guidelines

Molina Healthcare's Common Denial Tactics

Denying specialist referrals as not medically necessary

Applying Medicaid criteria to marketplace plans

Delays in prior authorization processing

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 Molina Healthcare

Molina serves many Medicaid/marketplace enrollees — cite state Medicaid rules if applicable

File a complaint with your state Medicaid agency for Medicaid-managed care plans

Request expedited review if treatment is urgent

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 Molina Healthcare'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.