Draft an appeal letter for the user to review and send
draft_appeal_letterDraft an appeal letter for the user to review and send. Use for "my insurer denied my MRI as not medically necessary, help me appeal" or "write an appeal letter for an out-of-network denial". Returns a letter as plain text with [brackets] for anything not given, a checklist of what to attach (denial notice, doctor's letter of medical necessity, records), and tips. It never sends or files anything.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| date | No | Date of service. | |
| name | No | Member's name. | |
| plan | No | Insurer or plan name. | |
| claim | No | Claim or reference number. | |
| doctor | No | Treating doctor's name. | |
| reason | No | Why the claim was denied: medical_necessity, emergency (said it wasn't an emergency), experimental, out_of_network, prior_auth, coding or generic. Plain words work too. Required unless denial_code is given. | |
| urgent | No | yes to ask for an expedited review. | |
| details | No | A sentence or two in the user's words on why the care should be covered. | |
| service | No | The care that was denied, like "MRI of the right knee". | |
| provider | No | Hospital, clinic or provider name. | |
| member_id | No | Member ID or Medicare number. | |
| plan_type | No | Same values as /v1/rights. Changes the wording for Medicare. | |
| denial_code | No | The reason code on the notice, like CO-50 or PR-197. Picks the reason when reason is left out, and is quoted in the letter. | |
| denial_date | No | Date on the denial notice. |