Only 0.2% of denied claims are ever appealed.
77% of denials are paperwork or plan-design errors — not medical judgment (KFF, 2024). Here is how people review their options.
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 $2,840 on outpatient procedure billed over the estimate
“My Good Faith Estimate said $1,800 but the final bill came in at $4,640. Under the No Surprises Act, the line-by-line comparison qualified for the federal Patient-Provider Dispute Resolution. The provider agreed to honor the estimate.”
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 $8,200 on biologic medication that needed prior authorization
“My doctor prescribed a biologic for an autoimmune condition but the insurer kept asking for more documentation. We drafted a letter that addressed every requirement upfront — step therapy history, clinical evidence, FDA labeling. The prior auth was approved on first submission.”
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 Medicare Advantage Appeal Outcomes (2022).
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