Help with your Basis Appeals letter

Before you buy (10)

Read this section if you are still deciding whether to buy or which tier to pick.

• Can I get help from a real person

  Yes, by email. Basis Appeals is a lean team, so we answer email within two business days rather than run a live phone line. Here is what we can and cannot help you with.

  3 min read

• Do you help with Medicaid denials

  Yes for Medicaid managed care plans, using the 42 CFR 438 appeal rules. Traditional fee-for-service Medicaid uses state fair-hearing procedures which vary by state.

  3 min read

• Do you help with Medicare Advantage appeals

  Yes. Medicare Advantage (Part C) uses a different rulebook than commercial group health, and Basis Appeals writes letters cited to the Part C reconsideration process.

  3 min read

• How fast will you deliver my letter

  Most drafts finish inside a minute. Here is what happens between clicking Preview and downloading the signed-ready PDF, and what to do if it stalls.

  2 min read

• How is this different from calling my insurance company

  Phone calls rarely reverse a denial. A written appeal starts a clock the insurer has to answer. Here is why the paper route matters.

  3 min read

• Is my information private

  What Basis Appeals stores, what it does not, and who can see it. Short version: your intake stays yours, we never sell it, and the letter belongs to you.

  3 min read

• Should I appeal or just pay it

  How to decide whether an appeal is worth your time. The number that matters, and the two situations where you should appeal even if the dollar amount is small.

  4 min read

• What if my denial isn't a coded reason

  Not every denial arrives with a nice CO-16 or PR-96 code. Here is how to figure out the effective reason from a plain-English denial letter, and what to type in the intake form.

  3 min read

• What's included in the $49 vs $199 tier

  Side-by-side of the three Basis Appeals tiers, what you get in each, and which one usually matches which situation.

  3 min read

• Will Basis Appeals write an appeal for my situation

  The situations Basis Appeals covers today, and the ones where you should use another tool or a lawyer instead.

  3 min read

After you buy (15)

You paid, you have the PDF, now what. Step-by-step guidance for the 30 to 45 days that follow.

• How long until the insurer responds

  The regulatory deadlines by plan type, plus the real-world timing you should plan around. Most decisions arrive between day 25 and day 55 after delivery.

  3 min read

• How to escalate to your employer (ERISA plans)

  If your plan is self-funded ERISA, your employer is the plan sponsor. Here is how to get HR to lean on the third-party administrator.

  3 min read

• How to escalate to your state insurance department

  The state DOI can pressure a plan that is stonewalling or making a bad-faith denial. Here is how to file and what to include.

  3 min read

• How to file a second-level appeal if the first is denied

  Not every plan offers a second internal level. Here is how to tell, how to file if it does, and when to skip straight to external review.

  3 min read

• How to keep a paper trail that helps a future lawyer

  If your appeal escalates, an attorney's first question is: 'show me the file.' Here is what to keep and how to organize it in real time.

  3 min read

• How to print and mail your appeal letter

  Print settings that make the packet look professional, and the mailing rules that matter for a defensible paper trail.

  3 min read

• How to request an external review

  External review is an independent third-party look at your appeal. Non-grandfathered plans have to offer it under ACA section 2719. Here is how to trigger it.

  4 min read

• How to send by certified mail (step-by-step)

  The USPS counter steps in the order the clerk expects. Total cost about $6 to $10. Bring the letter, ID, and card. Ten minutes.

  4 min read

• How to track your certified mail delivery

  Use the USPS tracking site with the number on your receipt. Here is what each status line means, and when a stall is a real problem.

  2 min read

• Should I attach my EOB, medical records, or both

  The short answer: always the EOB or denial letter; medical records only if the denial reason is medical necessity. Here is what to send and what to leave out.

  3 min read

• What if my insurer requests more information

  Respond in writing, respond fast, and keep a copy. Here is how to answer a plan's request without giving up your appeal rights.

  3 min read

• What if you don't hear back in 30 days

  30 days without a response is not always a problem. Here is the by-plan-type timeline for when silence becomes actionable, and what to do next.

  3 min read

• What to do if your insurer 'lost' your appeal

  Insurers claim they never received appeals more often than you would think. Your certified-mail record is the fix. Here is exactly what to say.

  3 min read

• When to hire an ERISA attorney (and how)

  For high-dollar or high-stakes denials, an ERISA attorney is worth their fee. Here is how to tell, and how to find one who does not charge you to look.

  4 min read

• You bought a letter, here's what happens next

  A five-step map of the next 30 to 45 days. What to do this week, what to expect from the insurer, and when to escalate.

  4 min read

Common denial situations (15)

One article per common denial code. What your letter emphasized and what the insurer is likely to say back.

• CO-109: Claim/service not covered by this payer/contractor

  Usually a coordination of benefits or wrong-payer routing issue. Often solvable by pointing the provider to the correct plan.

  3 min read

• CO-119: Benefit maximum for this time period or occurrence has been reached

  The plan says you have used up a benefit limit. Sometimes true, sometimes wrong. Here is how to tell.

  3 min read

• CO-125: Submission/billing error(s)

  Provider-side error most of the time. Here is how to help the provider fix it so you are not left holding the bill.

  3 min read

• CO-149: Lifetime benefit maximum has been reached

  Lifetime dollar limits on essential health benefits are illegal under the ACA. Here is what to argue and how.

  3 min read

• CO-151: Payment adjusted because information does not support this many/frequency of services

  The frequency cap. Sometimes the plan is right about the guideline; sometimes the medical situation justifies an exception.

  3 min read

• CO-16: Claim/service lacks information or has submission errors

  One of the most common and most reversible denial codes. Usually the plan lost paperwork the provider actually sent. Here is what to do next.

  3 min read

• CO-197: Precertification/authorization/notification absent

  The prior authorization denial. Sometimes solvable retroactively if the care was urgent or the plan's own portal did not accept the request.

  3 min read

• CO-204: This service, equipment, and/or drug is not covered under the patient's current benefit plan

  Similar to CO-96 but often more specific to formulary or DME exclusions. Here is how to identify an appealable case.

  3 min read

• CO-256: Service not payable per managed care contract

  The network contract denial. Usually the provider is out of network and the contract does not require the plan to pay them.

  3 min read

• CO-45: Charge exceeds fee schedule or maximum allowable amount

  CO-45 is usually a contract adjustment, not a denial you owe. Here is how to read it and when it is actually a member issue.

  3 min read

• CO-50: These are non-covered services because this is not deemed a medical necessity

  The most winnable appeal category if you have provider notes. Here is what your letter argues and what to prepare for.

  4 min read

• CO-96: Non-covered charge(s)

  The catch-all coverage denial. Winnable when your plan actually does cover the service. Here is how to prove it.

  3 min read

• CO-97: Payment is included in the allowance for another service/procedure

  The bundling denial. Provider-side to fix in most cases. Here is when it is worth an appeal from your side.

  3 min read

• PR-1: Deductible amount

  Not really a denial. This is a normal cost share indicating deductible has not been met. Here is when it needs correction.

  3 min read

• PR-96: Non-covered charge(s), patient responsibility

  The plan is saying you owe the amount because the service is not covered. Same coverage question as CO-96, but member is on the hook. Here is how to argue.

  3 min read

Troubleshooting (10)

Something looks off. Start here.

• How to request a refund

  The one-page refund policy in plain language. We refund when the product did not work. Here is how to ask and what to expect.

  3 min read

• I can't download my letter

  Fifteen minutes of checklist that solves 95 percent of download problems. Bookmark this before you email support.

  3 min read

• I need a copy of my letter and lost it

  We keep a copy of every letter for at least 90 days. Email support with your appeal ID and we deliver a fresh download link.

  2 min read

• I paid twice by accident

  Double charges happen. Here is how we find the extra charge and refund it, usually within one business day.

  2 min read

• My insurer said the appeal was untimely

  Timeliness disputes are worth fighting. Here is how to prove the appeal was on time and how to argue when it truly was late.

  3 min read

• My letter has a typo, can I edit it

  Small typos: hand-correct. Larger errors: regenerate. Here is the line between the two.

  2 min read

• The AI hallucinated something about my case

  We take this seriously. If the letter has an invented fact or a made-up case citation, email support and we regenerate at no charge.

  3 min read

• The date on my letter is wrong

  Wrong date is easy to fix. Here is when it matters and when it does not.

  2 min read

• The insurer address on my letter is wrong, what do I do

  Two ways to fix a wrong address on your PDF: get us to regenerate, or correct it by hand. Here is how to decide.

  3 min read

• The letter was returned undeliverable

  USPS sent it back. Here is how to fix the address and remail without losing your timeliness argument.

  2 min read

Refund policy (1)

The one-page policy in plain language.

• How to request a refund

  The one-page refund policy in plain language. We refund when the product did not work. Here is how to ask and what to expect.

  3 min read

Didn't find your answer?

Email support@basis-works.example. We answer every message within two business days. If you already bought a letter, please include your appeal ID (the long string in your download link) so we can find it quickly.