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
“The denial letter said "not medically necessary." The appeal cited clinical guidelines and my orthopedist's recommendation. The insurer reversed the decision.”
A California resident saved $8,900 on emergency room visit
“They denied my ER visit as "not a true emergency." The appeal invoked the prudent layperson standard under federal law. Fully overturned.”
A Florida resident saved $3,200 on hospital billing errors
“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.”
A Ohio resident saved $340/month on brand-name cholesterol medication
“My medication cost $380/month out of pocket. Lysco found a therapeutically equivalent generic at $40/month through a verified pharmacy discount.”
A New York resident saved $4,200 on physical therapy sessions
“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.”
A Illinois resident saved $1,850 on out-of-network anesthesiologist charge
“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.”
A Pennsylvania resident saved $6,750 on MRI and specialist referral
“They required me to try a cheaper treatment first. The appeal documented why the alternative was contraindicated. The exception was granted.”
A Georgia resident saved $215/month on diabetes medication
“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.”
A Michigan resident saved $15,600 on outpatient surgery
“The only qualified surgeon was out of network. The appeal demonstrated network inadequacy and the insurer agreed to cover at the in-network rate.”
A Arizona resident saved $2,100 on lab work overcharges
“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.”
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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