Is appealing your denied claim worth it? Enter your details to see the expected return on investment for every option.
Insurers deny claims knowing that almost nobody appeals. The data shows appealing works — most people just never try.
In most cases, yes. Studies show that ~60% of internal appeals result in overturned denials. Even for smaller claims, the expected value of appealing almost always exceeds the cost — especially with affordable tools like ClaimBack. The question isn't whether to appeal, but how to appeal most cost-effectively.
Our success rates are based on publicly available data from the Kaiser Family Foundation (KFF), HealthAffairs research, CMS external review reports, and ERISA Advisory Council findings. These represent averages across U.S. health plans. Your individual success rate may be higher if you provide strong medical evidence and cite the correct policy language.
For most appeals, no. A well-crafted appeal letter citing the right regulations, policy language, and medical evidence is often sufficient. Lawyers are typically only necessary for complex ERISA cases, very large claims, or when you've already exhausted internal appeals. ClaimBack generates letters with the same regulatory precision at a fraction of the cost.
You typically have multiple levels of appeal: internal appeal, a second internal review (for some plans), and external review by an independent third party. External reviews overturn about 45% of previously denied internal appeals. The cost of ClaimBack covers generating letters for each stage.
The cost depends on your approach. DIY is free but takes 5-10 hours of your time. Patient advocates charge $150-300/hr. Health insurance lawyers charge $300-500/hr. ClaimBack generates professional appeal letters for a flat $12 — making it the highest-ROI option by far.