When the claim is denied,
the letter is drafted.
Denvow turns a denial letter or EOB into a formal appeal to the insurer — citing the right state insurance code, ERISA procedure, or ACA appeal rights for the plan in front of you. Four short questions in, a complete appeal letter out.
- Successful appeals
- ~ 80%
- Ever appealed
- ~ 1%
- Letters
- $19 – $39
A draft, in real time
← switch the playbookAugust 13, 2026
Attention: Member Appeals Unit
Blue Cross and Blue Shield of Texas, Richardson, TX
Sent by: Maya Estrada
Address: 3421 W Mockingbird Lane, Dallas, TX 75235 · Member ID ending 4429
Re: Formal appeal of denial for CPT 27447 — knee arthroplasty, member M. Estrada
I am writing to formally appeal the denial of July 22, 2026 regarding the above procedure. The plan's determination letter references “Not medically necessary” yet supplies no clinical criteria document and no identifier for the reviewer. Under Texas Insurance Code § 4201.354 an adverse determination must be accompanied by the specific clinical criteria used. None are present.
The denial further fails § 4201.155(b) on its face — it does not describe the plan’s internal appeals pathway or the right to an external review by an Independent Review Organization within four months. I therefore reserve all available review remedies.
Cited: Tex. Ins. Code §§ 4201.354, 4201.155, 4201.206.
Respectfully submitted,
Maya Estrada
Tex. Ins. Code § 4201.354
Tap to switch the playbook
01 · What Denvow actually cites
Four playbooks. One letter per playbook. Written so a utilization-management nurse can act on it.
Generic AI writes the same appeal to every reviewer. Denvow pulls the exact statute, the exact plan-type procedure, and the exact letter structure for the denial reason on the desk — the way the people who handle your appeal every day expect to be addressed.
- I
State insurance code
Plan issued in TX? — Tex. Ins. Code § 4201.354. Issued in NY? — NY Ins. Law §§ 3214-a, 4914, 4904. Each state has its own adverse-determination statute, its own notice rules, its own external-review body.
- II
ERISA procedural language
Fully-insured group plans: 29 C.F.R. § 2560.503-1 — the right to the claims file under (m), the requirement that the plan name its clinical experts under (j)(4), the four-step full-and-fair review under § 503.
- III
ACA marketplace framing
Plans sold on the exchange: 45 C.F.R. § 147.136 — internal appeal, four-month external review, expedited review, Nondiscrimination required of clinical criteria.
- IV
Medical-necessity / coding argument
Built from the precise denial reason on the EOB — the cited diagnosis code, the LCD/NCD, the formulary step-therapy exception, the conservative-therapy timeline.
02 · Why a letter is the product
Almost nobody appeals. Not because they're wrong — because they don't know what to write.
Industry analyses put successful appeals near eighty per cent. The share of denied claims that are ever appealed sits around one per cent. The chance of reversal is good; the effort of a typed, well-cited letter is the barrier. Denvow closes that gap.
The user uploads the denial letter, answers four questions — insurer, plan type, denial reason, jurisdictional state — and receives a letter ready to print, mail, or upload to the insurer's appeal portal. The four short inputs are not a wizard: they are the discriminator between the four playbooks above, so the output is structured for the playbook, not sliced across all of them.
Positioning
The letter, not the lawyer.
Denvow is template-and-tooling, the way LegalZoom and Nolo have always kept risk low and support load shallow. If a denial needs counsel — litigation, an ERISA fiduciary complaint — Denvow says so plainly; for the long tail of denials that need a complete, cited appeal, Denvow writes the letter.
03 · How it works
Four short inputs. One formal letter on the way out.
01
Upload the denial letter
A PDF or photo of the EOB or denial. Denvow reads denial reason, line items, plan identifier, and reason code.
02
Answer four questions
Insurer, plan type (individual / fully-insured group / self-funded ERISA / ACA marketplace), denial reason from the letter, jurisdictional state the plan was issued in.
03
Draft the appeal
Denvow composes the letter — letterhead-style, dated, addressed to the right review role, with citations chosen from the playbook that matches the four inputs.
04
Print, mail, or submit
Download as a Word-compatible document, or route it through the insurer’s online appeal portal. Subscribers get a case-history entry and a plan-year timeline.
04 · Try a sample letter
Read the kind of letter Denvow produces.
The full hero card at the top of this page is a live sample. The four playbooks — state statute, ERISA procedure, ACA marketplace, and medical-necessity — are each a real letter a member has needed in the past twelve months. Flip between them using the tabs above.
Above — anchor sample, live
↑ Back to the live sampleWhat changes between playbooks
- →Citation: the cited authority swaps — a Texas Ins. Code section, an ERISA regulation, an ACA provision, or the LCD.
- →Addressee:the dedicated recipient — “Member Appeals Unit,” “Plan Administrator, ERISA Appeals Committee,” “Internal Appeals and External Review Coordinator,” “Medical Director, Utilization Management.”
- →Argument: the resubmitted clinical evidence and the procedural complaint that match the denial reason code on the EOB.
05 · Pricing
Pay for one letter. Or subscribe for the long case.
One-time letter
$19 – $39
Single denial. One formal appeal letter, complete with the playbook that matches your four inputs, ready to print, mail, or upload.
Order a letterOngoing chronic-condition case
Flat monthly
Unlimited drafts, a case-history notebook keyed to the member and plan-year, and an appeal timeline that surfaces the next workflow window before it closes.
Talk to usBroker / case-manager team
Volume rate
For benefits brokers, hospital case-management teams, and patient advocates handling multiple members — single sign-on, role-based access, central letter archive.
Get the team plan06 · Frequently asked
What people ask before they send us a letter.
Still uncertain? Email denvow@polsia.app.
07 · Send the denial
A denial letter on your desk is enough to start. Email us the EOB and the four answers — insurer, plan type, denial reason, state.
We reply within one business day. Plain language, plain price, plain letter — no intake call required.
Denvow is template-and-tooling, not legal counsel. For denials that need litigation, an ERISA fiduciary complaint, or any state-court remedy, we recommend counsel — and will say so when we see one.