Frequently asked questions

How does the platform map clinical codes to federal regulations?

The engine utilizes a specialized model to parse unstructured denial letters. It extracts Claim Adjustment Reason Codes (CARC), ICD-10 diagnoses, and CPT procedures, then cross-references these against primary legal sources including the Employee Retirement Income Security Act (ERISA) § 503 and the Affordable Care Act (45 CFR § 147.136).

Why shouldn't I use generic templates or standard AI tools?

Insurers employ automated systems that instantly flag and reject boilerplate appeals and generic AI outputs. A successful appeal must explicitly connect the clinical rationale of your specific provider to the legal mandates governing your exact plan type. Our platform architectures a bespoke legal argument that cannot be mistaken for a generic template.

Is my data secure while you process my document?

We enforce strict data minimization and zero-retention. Your denial letter is processed in memory, encrypted during transit using TLS 1.3, and permanently deleted after your appeal letter is delivered. We never sell, share, or train our models on your data.

Does this constitute legal advice?

No. The platform serves as an advanced drafting engine, not a law firm. It maps your denial to publicly available federal regulations to generate a starting point for your appeal. Always verify deadlines and consult a licensed professional for legal advice.

How long do I have to appeal?

Most employer (ERISA) plans allow 180 days from the denial date. ACA marketplace plans vary — always check your denial letter for the specific deadline. Do not wait — insurers can reject late appeals on procedural grounds regardless of the merit of your case.

What is ERISA and does it apply to me?

ERISA (Employee Retirement Income Security Act) governs most employer-sponsored health plans in the US. If you get insurance through your job, ERISA almost certainly applies. It requires your insurer to provide a full and fair review of any denied claim under ERISA § 503 and 29 CFR § 2560.503-1.

What is ACA and does it apply to me?

The Affordable Care Act governs plans purchased on Healthcare.gov or your state exchange, as well as many individual and small-group plans. ACA plans have strong internal appeal and external review protections under 45 CFR § 147.136.

Does this work for Medicare?

Not currently. Rebuttal covers employer (ERISA) plans and ACA marketplace plans. Medicare has a separate appeals process through CMS with different regulations and timelines. We may add Medicare support in the future.

Does this work for dental or vision insurance?

Dental and vision plans are typically separate from medical insurance and governed by different rules. Rebuttal currently covers medical insurance denials only.

How long does the appeal process take?

After you submit, ERISA plans must respond within 60 days for standard claims and 72 hours for urgent claims. ACA plans have similar timelines. External review, if needed, typically adds 45–60 days.

What if my appeal is denied again?

You have further options: external independent review (binding on the insurer for ACA plans), complaints to your state insurance commissioner, and for ERISA plans, a complaint to the Department of Labor's Employee Benefits Security Administration (EBSA) at dol.gov/agencies/ebsa.

Can my doctor help with my appeal?

Yes — a letter of medical necessity from your ordering physician is one of the strongest pieces of supporting documentation. Visit our submission guide for exactly what to request and how to ask for it.

Will this work for any insurer?

Yes — the federal regulations we cite apply to all qualifying plans regardless of which insurer administers them. UnitedHealthcare, Aetna, Cigna, Blue Cross — all are bound by the same federal appeal requirements under ERISA and the ACA.

How do I contact Rebuttal?

For questions about your letter or the service, reach us at hello@sendrebuttal.com.