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.

Can Lysco predict my appeal result?

Appeal outcomes vary by plan, facts, and documentation. Public data shows consumers rarely appeal denied claims and many denials involve administrative or plan-design issues. Lysco helps users understand the denial, prepare the paperwork, and decide what to do next; it does not predict results.

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?

EOB translation is always free and you get one free document analysis and one free appeal letter. Per case: $29 for a denial appeal, medical bill review, or surprise bill dispute. Or upgrade to Pro ($29/mo) or Annual ($199/year) for unlimited everything across all five pillars including the prior authorization helper. 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.

Medicare Advantage Appeals

Medicare Advantage said no. You may have appeal rights.

Medicare Advantage plans denied 4.1 million prior-auth requests in 2024. Medicare has defined appeal levels, deadlines, and documentation rules that are worth checking before you accept the first decision.

Upload your denial letter. Lysco drafts the appeal with Medicare citations, plan-specific policy references, and the deadline calendar. Your first appeal letter is free.

Appeal my denial — free See pricing

6 min read Updated April 2026

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The numbers

53M

Prior-auth requests made to MA insurers in 2024

KFF, 2024

4.1M

Of those requests denied (7.7%)

KFF, 2024

+56%

Jump in MA denials vs prior year

AMA, 2026

Medicare appeal levels may be available

Medicare.gov

Aggregate data from published government and industry reports. Individual results vary by plan, provider, and circumstances.

What changed in 2026 — and why this is the moment to appeal

The CMS Interoperability and Prior Authorization Final Rule took effect January 1, 2026. For the first time, Medicare Advantage insurers must:

Respond to urgent prior-auth requests within 72 hours and standard requests within 7 days.
Give a specific reason for every denial — no more vague “not medically necessary.”
Publicly report their prior-auth metrics by March 31 each year, including how many were approved, denied, and overturned on appeal.

Translation: insurers can no longer hide behind boilerplate. If your denial lacks a specific reason, that alone is often grounds for overturn. Lysco catches these procedural violations automatically when you upload your denial.

Common reasons MA plans deny — and what works

Not medically necessary

Plans must apply Medicare coverage rules — not stricter internal criteria. Lysco cites the specific Medicare National Coverage Determination (NCD) or Local Coverage Determination (LCD) that applies.

Experimental or investigational

If Medicare itself covers the procedure, the MA plan must too. We cite the CMS manual sections that override the plan’s denial.

Out of network

Emergency care and post-stabilization are protected. We cite 42 CFR §422.113 and the continuity-of-care rules.

Missing documentation

77% of all insurance denials are paperwork or plan-design errors (KFF, 2024). We identify exactly what’s missing and draft the letter.

Helping a parent, spouse, or loved one?

Most Medicare Advantage appeals are filed by family members, not the patient. Lysco is built for that — you can upload a denial on behalf of someone else, and every letter we draft uses the right language for a caregiver or authorized representative.

No account juggling. One Lysco account can hold cases for multiple family members. Each case is kept separate and private.
Representative-ready letters. Every draft cites the correct CMS Appointment-of-Representative rules (CMS-1696) and, when needed, the plan’s authorized-representative process so the plan can’t reject the appeal on a technicality.
Post-acute and skilled-nursing denials. The algorithmic denials under scrutiny in Estate of Lokken v. UnitedHealth overwhelmingly hit seniors discharged from hospitals. Lysco flags these specifically and cites Medicare’s own coverage standard, not the plan’s internal rule.
Deadline tracking. Medicare Advantage appeal windows are short — sometimes 60 days, sometimes 72 hours for expedited review. We calculate the deadline from the denial date and remind you before it closes.

Appeal on behalf of someone else

How Lysco handles Medicare Advantage appeals

Upload the denial letter

A photo, PDF, or the letter text. We read it in seconds.

Lysco identifies the real reason

We check the denial against Medicare coverage rules, your plan’s Evidence of Coverage, and the new 2026 transparency requirements.

We draft the appeal letter

With specific Medicare citations, plan policy references, and the right deadline. You review, edit, and send.

Escalation if needed

If your first appeal is denied, we guide you through the independent external review — binding on the plan.

Start your appeal — free

Your first appeal letter is free. Takes 30 seconds to upload. No credit card needed.

Appeal my Medicare Advantage denial

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Lysco is an informational tool — not a law firm, medical provider, or licensed patient advocate. Statistics cited are from published KFF, HHS OIG, AMA, and CMS reports. Individual appeal outcomes vary by plan, denial reason, clinical evidence, and circumstances. This page is not legal or medical advice.