How are the success probability estimates calculated?+
The estimates are based on published data from CMS (Centers for Medicare and Medicaid Services), AHIP (America's Health Insurance Plans), and independent studies on insurance appeal outcomes. They represent industry-wide averages — individual results vary based on the strength of your documentation, specific plan terms, and the reviewer.
What is the "expected value" calculation?+
Expected value is a standard financial concept: multiply the potential outcome (your claim amount) by the probability of achieving it. If your claim is $2,000 and your success probability is 50%, your expected value is $1,000. This doesn't mean you'll receive $1,000 — it means that on average, across many similar cases, you'd expect to recover that amount.
Is it worth hiring a lawyer for my appeal?+
For most claims under $5,000-$10,000, a lawyer is not cost-effective. Lawyers typically charge $300–$500/hour and may require a retainer. Patient advocates charge $100–$200/hour. ClaimBack generates the same regulation-citing letter quality for $12, saving you dozens of hours and hundreds of dollars. For very large claims or bad faith litigation, consulting an attorney makes sense.
What if my claim amount is small — is it still worth appealing?+
Yes. Even for smaller claims, the appeal process establishes a record, and repeated denials can be evidence of a pattern. More importantly, the principle matters: insurance companies count on most people not appealing. Appealing sends a signal and costs the insurer money to review — which is why ~60% of appealed denials get overturned.