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.

TRICARE (Military Health)

Also known as: TRICARE, Tricare, Military Health, Defense Health Agency

TRICARE PrimeTRICARE SelectTRICARE for Life

Common Denial Patterns

Referral and prior authorization denials
Network restrictions (Prime vs Select)
Benefit exclusions for certain services
Timely filing denials for claims from civilian providers

Appeal Best Practices

1File a formal appeal with the TRICARE regional contractor
2If denied, appeal to DHA (Defense Health Agency) — independent review
3Reference TRICARE Policy Manual for specific coverage rules
4Document any access issues at military treatment facilities

Known Weaknesses

Not subject to state insurance regulations
DHA independent review is available and effective
Congressional constituent service offices can inquire on behalf of service members
TRICARE ombudsman can help navigate the appeal process

Contact & Response

Best Contact Method

Regional contractor > DHA appeal > TRICARE ombudsman

Typical Response Time

30-60 days (contractor), 60-90 days (DHA)

Internal Criteria Used

TRICARE Policy Manual
DHA clinical criteria

General Tips

TRICARE is governed by federal law (10 USC Chapter 55), not state insurance laws
Appeals go through the Defense Health Agency (DHA), not state regulators
TRICARE uses clinical criteria similar to civilian insurers but with military-specific rules
Active duty service members have different appeal rights than retirees/dependents

Have a denial from TRICARE (Military Health)?

Upload your denial letter for free analysis. Lysco uses TRICARE (Military Health)-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.