Fight the denied claim with a proper letter
A correctly-structured appeal letter citing your policy language, plus a call script; a real fraction of appeals succeed.
The problem
A denied insurance claim or surprise bill, and the appeal process is designed for you to give up.
What you get
A working system with the steps, tools, checkpoints, and expected return made explicit.
- Setup
- 45 minutes
- Back each week
- 0.5 hours
- Difficulty
- starter
Expected return
The working case
A planning estimate, not a guaranteed result. Measure the first four weeks against your own baseline.
24
hours returned per year
At 0.5 hours/week across 48 working weeks.
2
weeks to earn back setup
Compare the setup estimate with the weekly time returned.
Operating contract
Input
The source material, constraints, and examples a human would need to do this work well.
Checkpoint
A person reviews judgment calls, sensitive content, unfamiliar tools, and irreversible actions.
Success signal
Track time returned, corrections required, and exceptions. Keep it only if the measured result compounds.
Before you start
- ·The denial letter and your policy document
The steps
- 01
Gather: the denial letter, the relevant policy section (search the PDF for the treatment name), and the bill.
- 02
Draft the appeal.
Copy this prompt
My insurance denied a claim. Denial reason: [paste]. Policy language: [paste relevant section]. Situation: [what happened, dates, provider]. Write a firm, factual appeal letter that: cites the policy language, addresses the stated denial reason, requests specific reconsideration, and asks for the denial rationale and reviewer credentials in writing if refused. Also give me a 30-second phone script for the claims line.
- 03
Send by the method the denial letter specifies, keep dated copies of everything, and calendar the response deadline.
What it runs on
- Claude
Long policy documents fit in one conversation.
Where this goes wrong
- Appeals have strict deadlines, often 30-180 days; find the deadline first, everything else second.
- Stay factual in the letter; the sympathetic story goes in one sentence, the policy citation does the work.
Definition of done
Run it for four weeks. Then make it earn its place.
- □ Baseline the manual time before launch.
- □ Keep a human approval step for consequential output.
- □ Record corrections and exceptions, not just successes.
- □ Expand, revise, or retire it after the first review.
Build the system around it
Related workflows
If this one stops working, tell us. Three reports in a month and it leaves the library until a person has looked at it again.