Sample case — every detail is made up
This is what one appeal looks like from start to finish. You make every decision; the software reads, computes, drafts, tracks, and, when you say so, sends. The buttons here are disabled because this isn't a real case.
Where this case stands
Letter read and explained
2026-01-15 · medical necessity
Appeal approved and filed
2026-02-03 · fax receipt kept
Decision recorded: upheld
2026-03-28 · confirmed by the patient
External review request drafted
request window ends 2026-05-15
External review decision
every route shown with its rule
✓ 1. Your denial letter, read and explained
Insurer: Acme Health Plan
Denial reason: Medical necessity: The insurer says this treatment wasn't medically necessary or didn't meet their clinical criteria.
Service: Weekly outpatient psychotherapy (CPT 90837), ongoing since October 2025
Plan type you confirmed: Employer plan, insured by an insurance company (state rules)
Amount at stake: $185.00
Computed deadlines
From the notice date on the letter (2026-01-15) plus the published minimum. The letter itself controls if it states a different date.
What appeals for this reason commonly include
✓ 2. A short interview, then a drafted letter you edit and approve
AI-generated draft from your answers — review before use.
Acme Health Plan Appeals Department Re: Appeal of denial — Member ID ACM-998877, Claim CLM-2026-004521 Service: weekly outpatient psychotherapy (CPT 90837), ongoing since October 2025 To the Appeals Department: I am appealing the denial dated January 15, 2026. The denial states that continued weekly psychotherapy does not meet the plan's medical-necessity criteria for level of care. The enclosed letter from my treating psychologist, Dr. R. Example, states that weekly sessions are medically necessary to treat my diagnosed condition and that reducing frequency would risk relapse, and it references the treatment history documented in the enclosed records (Exhibits B and C). The denial does not identify the specific clinical criteria that were applied or the plan provision relied on. I request that you identify them in writing, as the claims-procedure rules require the specific reason and the plan provisions on which a denial is based to be stated. This plan covers mental-health benefits, and federal and state parity rules require that the standards used for mental-health services be comparable to those used for medical and surgical services. I ask that you state how the criteria applied to this claim compare with those applied to comparable medical services. I request that the denial be reversed and coverage approved for the sessions from January 2026 onward. Please send your decision to me at the address on file within the time the plan's procedures allow. Enclosures: Exhibit A, denial letter; Exhibit B, letter of medical necessity; Exhibit C, treatment records. Sincerely, Jordan Sample
Exhibits selected: Denial letter, Letter of medical necessity, Treatment records.
✓ 3. Filed, with proof
You can send the packet yourself (certified mail or fax) and confirm the date here, or sign a short authorization and have it faxed for you, with the carrier's delivery receipt kept on the case.
Filed: 2026-02-03
Fax receipt: 6 pages to (555) 010-0199, delivered 2026-02-03, ref fax_01HZ...demo
Insurer decision due: around 2026-03-16, counted from the filing date, under the published timeline. We remind you a week before and the day after.
✓ 4. The insurer's response arrives
Fax received 2026-03-28 from (555) 010-0199, matched to this case by the reference code on the cover sheet, and confirmed by the patient before anything was shown.
Looks like a decision
The plan states that the appeal was reviewed by a licensed psychologist and that the denial is upheld because the submitted records do not document functional impairment at a level requiring weekly sessions. The letter says the member may request an independent external review within four months.
Mentions a deadline of 2026-07-28 — confirm this on the original document.
5. The next document is already draftedyou are here
You recorded the outcome as upheld, so the external review request is drafted and waiting. Edit it, approve it, and send it. The request goes to the reviewer named in the final denial letter.
AI-generated draft from your answers — review before use.
Independent Review Organization (address as stated in the plan's final denial letter) Re: Request for external review — Member ID ACM-998877, Claim CLM-2026-004521 I am requesting an independent external review of Acme Health Plan's decision, dated March 28, 2026, to uphold its denial of weekly outpatient psychotherapy after my internal appeal. The final denial states that the submitted records do not document functional impairment at a level requiring weekly sessions. The enclosed letter of medical necessity and treatment records (Exhibits B and C) document the diagnosis, the treatment history, and my treating psychologist's clinical judgment that weekly sessions are necessary. I am submitting this request within the four-month window stated in the final denial letter. Enclosed are the original denial, my internal appeal, the plan's final decision, and the supporting records. Sincerely, Jordan Sample
6. What comes after, laid out as options
We show every route with the rule it rests on. We never pick one for you.
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Read my own denial letterTarian is a self-help software tool, not a law firm, insurance company, or medical provider. Nothing here is legal, medical, or insurance advice, and it is not a substitute for the advice of an attorney. You review and approve everything before it's used.