Most insurance denials are overturned when appealed — over 80% of appealed Medicare Advantage prior authorizations. Overturn Health turns four hours of staff paperwork into a fifteen-minute physician review, with a signature-ready appeal in under 48 hours — and the success fee is only due when you get paid.
No EHR integration. No setup fee. You're live the day you say yes.
That spread is unclaimed revenue for your clinic and delayed care for your patients. Every unappealed denial is a decision the payer made without a fight.
win when appealed. Over 80% of appealed Medicare Advantage prior-auth denials are overturned — 54% of private-payer denials.
ever get appealed. A strong appeal takes hours of chart review and policy research your staff doesn't have.
Our engine does the research and drafting; your physician stays the decision-maker on every single output.
Forward the denial letter and relevant chart pages through our secure, BAA-covered intake. No EHR integration, no IT project.
The engine retrieves the payer's published medical policy — the version in effect on the denial date — and maps every criterion against the patient's chart.
You get a physician-ready appeal letter plus a one-page peer-to-peer briefing sheet, every claim carrying a date-stamped chart citation.
The physician reviews and signs; submission runs through your existing Availity workflow. We track appeal windows and P2P deadlines so nothing lapses.
Four hours of staff work becomes a fifteen-minute review.
Every appeal is built on a criteria matrix: the payer's policy requirements on one side, date-stamped citations from the patient's own chart on the other. Our no-invention rule means every claim is verifiable — or flagged as missing before it ever reaches a signature line.
Recovery firms take 20 to 35 cents of every dollar they recover. We average about twelve — and the success fee is only due when you get paid. Medicare and Medicaid appeals are flat-fee, fixed in advance, because federal rules require it.
$400–500 per location per month + volume-tiered success fees. Start with a 90-day paid pilot at 2–3 locations — rollout pricing pre-agreed against a defined win rate, so the decision is arithmetic.
Clinics in Texas, Arkansas, Oklahoma, and Louisiana juggle two different Blue Crosses, four state rulebooks — and now Medicare's new WISeR prior-auth reviews in Texas and Oklahoma. All four states sit under one Medicare contractor (Novitas, Jurisdiction H), and our policy library is built around exactly this footprint, starting with interventional pain, spine, and orthopedic practices.
Policy library versioned monthly for the top interventional pain CPT codes.
An independent company with its own criteria and appeal process — handled natively.
CMS's WISeR model (2026–2031) brings new prior authorization to epidural steroid injections, vertebral augmentation, and implanted nerve stimulators — exactly what our flat-fee Medicare line is built for.
Appeals cite the payer policy version in effect on the date of your denial.
Overturn Health operates as a HIPAA Business Associate with a compliance posture designed in from day one.
Every appeal is reviewed and signed by your physician — the human-in-the-loop on every output.
Signed Business Associate Agreements with every clinic before a single record moves.
Every chart claim carries a verifiable, date-stamped citation — or is flagged as missing.
PHI lives exclusively inside BAA-covered infrastructure, encrypted in transit and at rest.
Send us three real denials. If we don't turn them into appeals your physician is proud to sign — inside 48 hours — you've lost nothing.