Insurance Denial Appeals and Claim Help
A denial letter is designed to be the end of the conversation. It rarely is.
Most denied claims are never appealed — and a large share of those that are appealed get overturned. The obstacle usually isn't the merits of the case. It's that appealing requires knowing which deadline applies, which form the plan actually reads, what language the reviewer is looking for, and who to escalate to when the first answer is no. Families discover all of this while someone they love is sick.
That's the work we do.
What we actually do with a denial
Read the denial for what it really says
Denials cite a reason code and a plan provision. Both are often wrong, or applied to the wrong service. That's the first thing we check.
Pull the record that supports the claim
Appeals succeed on documentation — physician notes, orders, prior authorizations, therapy evaluations. We know what's missing and how to get it.
Write and file the appeal
Internal appeal first, then external review if the plan holds. Each level has its own deadline and its own standard. Missing a deadline usually ends the case permanently.
Escalate when the plan stalls
State insurance department complaints, Medicare grievances, and plan-level escalation all exist. Most families don't know they do.
Decode the bills that follow
An overturned denial doesn't automatically fix the balance. We check that the plan actually reprocessed and that you were billed correctly.
Why a clinician gets further than a form letter
Twenty-five years inside the systems that issue these denials
We are not attorneys, and we do not provide legal advice. What we provide is clinical and administrative knowledge of how these systems actually decide.more than 25 years in healthcare, and a Professional member of the Aging Life Care Association.
That combination matters here more than it sounds. Insurance denials for rehabilitation, skilled nursing, home health, and durable medical equipment turn on clinical questions: was the therapy skilled or maintenance, was the level of care justified, did the documentation establish medical necessity. Those are questions a therapist and a nursing home administrator have answered from the inside, for decades. An appeal that speaks the reviewer's clinical language reads differently than one that doesn't.
We are not attorneys, and we do not provide legal advice. What we provide clinical and administrative knowledge of how these systems actually decide.
What this costs
A single consultation — $200
Sixty minutes with us on one specific problem, including a written Action Plan. If you have one denial letter and one question, this is often all you need. Evenings and weekends are $300; federal holidays are $400.
A Comprehensive Assessment and Evaluation — $600
An in-person or virtual visit anywhere in New York State, a full review of the patient's medical, physical and functional needs, a written Action Plan, and referrals to the programs and providers that fit. This is the right starting point when the situation is bigger than a single claim.
Ongoing support starts at $200 a month
After an assessment or consultation, you can move onto a monthly plan — from a single hour of care management each month up to daily support during a crisis. You're not watching a meter run; you know your monthly number before you call.
This is private pay
We don't bill insurance for our services — which is precisely what lets us work only for you, with no obligation to any plan, hospital or agency. Payment is by check, ACH, money order, Zelle, or credit card.
What happens when you call
1. You call or email us
Describe the situation — the denial, the bill, the notice you don't understand. Call 914-719-7593 or email support@patientadvocatesofamerica.com.
2. We tell you which starting point fits
A $200 consultation if it's one focused problem, a $600 comprehensive assessment if it's broader. We'll say plainly if we don't think you need us.
3. You get a written Action Plan
Not verbal advice you'll forget by dinner — a document with specific recommendations and next steps.
4. If you want ongoing help, you choose a monthly plan
Only after the assessment or consultation, so you're choosing with real information. You can change or cancel it month to month.
One thing to know up front
We are not an emergency service. We don't provide 24-hour response or emergency medical monitoring. In a medical or safety emergency, call 911.
Where we work
Long Island, and New York City
We work with families across Suffolk County and Long Island — including Bellport, Patchogue, Brookhaven, and the surrounding towns — and in New York City, from our Harlem office.
We know the hospital systems, the plans that operate in these markets, and the appeal pathways specific to New York State.
Bellport — 1 Station Ct, Suite 3, Bellport, NY 11713
East Patchogue — 1 South Durkee Lane, East Patchogue, NY 11772
Harlem / New York City — 1925 Adam Clayton Powell Jr. Blvd, New York, NY 10026
