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.

Molina Healthcare

Also known as: Molina, Molina Healthcare

MedicaidMedicare AdvantageACA Marketplace

Common Denial Patterns

Prior authorization denials for specialty referrals
Medical necessity denials for durable medical equipment
Formulary restrictions on specialty medications
Home health and rehabilitation service limits

Appeal Best Practices

1For Medicaid denials, always request a state fair hearing
2Document functional limitations for DME and rehab denials
3Include progress notes showing ongoing medical necessity
4Reference specific Molina coverage guideline numbers

Known Weaknesses

Medicaid fair hearings are independent and have high overturn rates
DME and home health denials frequently overturned with proper documentation
Network limitations in rural areas create access-based appeal opportunities

Contact & Response

Best Contact Method

Member services > Written appeal > State fair hearing

Typical Response Time

30 days (internal), varies by state

Internal Criteria Used

MCG
Molina Clinical Guidelines

General Tips

Molina primarily serves Medicaid and low-income populations
State Medicaid fair hearing rights apply to most Molina denials
Molina publishes coverage guidelines — reference specific policies
For marketplace plans, use standard ACA appeal process

Have a denial from Molina Healthcare?

Upload your denial letter for free analysis. Lysco uses Molina Healthcare-specific intelligence to identify weak points and draft your appeal.

Upload Your Denial — Free

This information is for educational purposes based on publicly available data including CMS reports, state insurance department filings, and published insurer guidelines. It does not constitute legal, medical, or financial advice. Individual results vary. Verify all information independently and consult qualified professionals before acting.