Your denial isn't the final word.
We'll appeal it for $49.
Fill out this form and we handle the rest. A formal administrative appeal is drafted, reviewed for accuracy by our team, and faxed directly to your carrier. Your personal information is encrypted in your browser before it leaves your device.
Your Denied Claim
Tell us what was denied. This information is not encrypted. It is the anonymized case data we use to draft your appeal.
Procedure codes from your denial letter or EOB.
Diagnosis codes if listed. Leave blank if not shown.
Open your denial letter or EOB. Look for the section titled "Reason for Denial," "Explanation of Determination," or similar. Copy and paste it here.
Your Information
This information is encrypted in your browser using 256-bit encryption before it's stored. We never see your name, date of birth, or insurance IDs in readable form.
Your name, date of birth, member ID, and group ID are encrypted using RSA-OAEP + AES-256-GCM before leaving your device. Only the operator's private key (stored locally, never uploaded) can decrypt this data.
Usually printed on the front of your card.
Used to send a verification code when you check your case status.
For transmission confirmation. Encrypted with your other information.
Authorization & Signature
Federal law requires a signed authorization before we can communicate with your insurance carrier on your behalf.
HIPAA Authorization & Limited Power of Attorney
I, the undersigned, hereby authorize ARIS / Claim Relief Tools ("Representative") to act as my authorized representative and limited attorney-in-fact for the sole purpose of filing, tracking, and managing an administrative appeal of the insurance claim denial identified in this intake form.
Pursuant to 45 CFR §164.508 (HIPAA Privacy Rule), I authorize my insurance carrier and its affiliates to release to my Representative all health information, claim records, Explanation of Benefits documents, and correspondence reasonably necessary to evaluate, draft, and submit an administrative appeal on my behalf.
This authorization is limited to the specific denied claim identified herein. It does not grant authority to make binding legal decisions, initiate litigation, or access medical records beyond what is directly related to the identified claim. This authorization may be revoked at any time by contacting Claim Relief Tools in writing; revocation will be effective upon receipt.
I understand that my personal health information will be used solely to draft and file the administrative appeal, will be encrypted at rest, and will not be sold, shared for marketing, or disclosed to any party beyond those necessary to complete the appeal.
I acknowledge I am the patient or the legal guardian/authorized representative of the patient named in this form.
Your signature is encrypted with your personal information and never stored in readable form.
Review and Confirm
Check your details below. Payment is processed through Stripe. Your information is encrypted before it leaves this page.
Case Summary
How it works
Your information is encrypted in this browser, stored securely, and your payment is confirmed through Stripe.
An appeal is drafted using your claim details. Your personal information is never shared with any AI system.
A human reviewer reads and approves the appeal before it is faxed to your carrier. Nothing is sent without human sign-off.
You receive confirmation when the appeal is transmitted. No further action needed from you.
$49 flat fee
One appeal. No subscription. No hidden fees.
Appeal submitted successfully
Payment confirmed. Your case is secured and in the queue. We'll draft and transmit your appeal. No further action needed from you.
What happens next
- Appeal draft generated (typically within 1 business day)
- Human review and final document assembly
- Secure fax transmission to your carrier
- Transmission confirmation sent to you
Questions? Contact support@necessity.support