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The Problem

Americans lose over $50 billion to unfair denials every year.

Yet 82% of prior authorization appeals succeed when filed (AMA, 2024). Here is how people are fighting back.

Real Results from Real People

Illustrative examples based on published Medicare appeal statistics and typical case outcomes across denial types.

A Texas resident saved $12,400 on knee surgery authorization

Prior Authorization DenialNational PPO plan

The denial letter said "not medically necessary." The appeal cited clinical guidelines and my orthopedist's recommendation. The insurer reversed the decision.

22 days to resolution
Denial Appeal

A California resident saved $8,900 on emergency room visit

Emergency Room DenialMedicare Advantage plan

They denied my ER visit as "not a true emergency." The appeal invoked the prudent layperson standard under federal law. Fully overturned.

18 days to resolution
Denial Appeal

A Florida resident saved $3,200 on hospital billing errors

Duplicate ChargesRegional health system

The itemized bill had duplicate charges for lab work and an inflated facility fee. After requesting a corrected bill, they removed over $3,000 in errors.

11 days to resolution
Bill Correction

A Ohio resident saved $340/month on brand-name cholesterol medication

Formulary ExclusionNational HMO plan

My medication cost $380/month out of pocket. Lysco found a therapeutically equivalent generic at $40/month through a verified pharmacy discount.

5 days to resolution
Rx Savings

A New York resident saved $4,200 on physical therapy sessions

Medical Necessity DenialEmployer-sponsored plan

Insurance said 12 PT sessions were "sufficient." The appeal included my doctor's letter explaining why continued therapy was medically necessary. They approved 24 more sessions.

28 days to resolution
Denial Appeal

A Illinois resident saved $1,850 on out-of-network anesthesiologist charge

Balance BillingLarge employer plan

I had no choice in the anesthesiologist, but got balance-billed anyway. The No Surprises Act applied, and the charge was reduced to the in-network rate.

14 days to resolution
Bill Correction

A Pennsylvania resident saved $6,750 on MRI and specialist referral

Step Therapy DenialIntegrated health system

They required me to try a cheaper treatment first. The appeal documented why the alternative was contraindicated. The exception was granted.

19 days to resolution
Denial Appeal

A Georgia resident saved $215/month on diabetes medication

Tier ExceptionNational PBM

My insulin was on a high-cost tier. By finding a manufacturer patient assistance program and pharmacy discount card, the monthly cost dropped from $290 to $75.

7 days to resolution
Rx Savings

A Michigan resident saved $15,600 on outpatient surgery

Out-of-Network DenialState marketplace plan

The only qualified surgeon was out of network. The appeal demonstrated network inadequacy and the insurer agreed to cover at the in-network rate.

35 days to resolution
Denial Appeal

A Arizona resident saved $2,100 on lab work overcharges

Upcoded ServicesIndependent lab

Standard blood panels were billed at specialist-level rates. After comparing with Medicare reference rates and requesting an itemized bill, the lab corrected the charges.

9 days to resolution
Bill Correction

Examples based on published Medicare appeal statistics and typical case outcomes. These are illustrative scenarios, not actual Lysco user results. Individual outcomes vary based on case specifics, insurer policies, and applicable laws. Sources: KFF (2024), AMA (2024), HHS OIG (2018).

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