Question 1

What is Denial OS?

Accepted Answer

It's the tool you've always needed for fighting insurance denials. You paste in your EOB (the explanation they send you saying why they didn't pay), and Denial OS writes a professional appeal letter — the kind that gets results. It cites your contracted rate, the regulations the insurance company has to follow, and the exact deadline they have to respond. You download the letter, fax or send it, and track whether they pay.

Question 2

Do I need to know anything about insurance appeals to use this?

Accepted Answer

No. That's the whole point. You paste in the EOB text. Denial OS reads it, pulls out the important pieces (what code, what payer, how much they owe you), and writes the letter. You review it, hit send, and you're done. The legal language and regulation citations are in the letter — you don't have to write any of it.

Question 3

How long does it take to write an appeal letter?

Accepted Answer

Under 5 minutes from start to finished letter. Paste the EOB — takes 30 seconds. Review the parsed data — 1 minute. Read through the letter — 2 minutes. Send or download — 30 seconds. That's it. Compare that to the 4–6 hours a manual appeal takes.

Question 4

What denials can I fight with this?

Accepted Answer

The most common and most winnable ones: claims paid at $0 when they should have been paid (bundling errors — denial code CO-97), payments that came back below your contracted rate (CO-18), modifier denials (CO-4, CO-5), documentation/information requests (CO-16), prior auth denials when the service was medically necessary, and "non-covered service" denials that were incorrectly applied.

If you're not sure whether a denial is winnable, paste it in anyway. Denial OS will tell you whether it can generate an appeal and what the odds look like based on similar cases.

Question 5

How does Denial OS know my contracted rate?

Accepted Answer

Since 2022, insurance companies are required by law to publish their contracted rates in a public file. We've downloaded and parsed those files for every major commercial payer — Anthem, Aetna, United Healthcare, Cigna, Blue Shield of California, and more. When you file an appeal, we look up your NPI and your procedure code and find the exact dollar amount the payer agreed to pay you. Then we put that number in your letter.

Question 6

Will the insurance company take this letter seriously?

Accepted Answer

Yes. The letter looks like it was written by a healthcare attorney, because we trained on the best appeal letters in the industry. It cites regulations by name. It cites your contracted rate by dollar amount. It gives the payer a specific deadline to respond (per state law). Payers know when they're looking at a serious appeal vs. a form letter that's easy to ignore. This is not a form letter.

Question 7

What if the insurance company denies the appeal anyway?

Accepted Answer

Then we write a second one — a second-level appeal that escalates. This one is more aggressive: it requests an independent medical review, cites the payer's failure to honor the first appeal, and includes a demand letter referencing the regulatory timeline. If the payer misses the deadline for responding to your appeal (in California, that's 30 business days for commercial plans), we help you file a complaint with the California Department of Insurance in one click.

Question 8

What is a state insurance commissioner complaint and when does it apply?

Accepted Answer

Every state has an insurance commissioner — a government office that regulates insurance companies. If an insurance company violates their own rules (like missing the legal deadline to respond to your appeal, or denying a claim they're contractually obligated to pay), you can file a complaint. Commissioners investigate these and can fine payers. It's one of the most effective tools available — many payers pay up quickly once a commissioner complaint is filed, because the regulatory scrutiny is more expensive than just paying the claim.

Denial OS pre-fills the complaint form for you. You review it and file. We track the case.

Question 9

Is this only for physical therapy / chiropractic offices?

Accepted Answer

No. Denial OS works for any independent practice that bills commercial insurance. Physical therapy, occupational therapy, speech-language pathology, behavioral health, chiropractic, acupuncture, podiatry, optometry, audiology, and more. We don't currently support hospital billing or large health system claims — those have different processes and usually have dedicated billing departments.

Question 10

Does the patient need to know I'm filing an appeal?

Accepted Answer

For provider-level appeals (you disputing the payer's payment to your practice), no — the patient doesn't need to be involved. You're appealing as the provider. The patient's name and insurance ID will appear on the letter, but it's your appeal, not theirs.

For patient-facing cases (like a big hospital bill the patient wants to fight), we have a separate patient portal (coming in Phase 2) where the patient files the appeal themselves.

Question 11

Do I need to connect my practice management software?

Accepted Answer

Not for the basic version. You paste or upload the EOB text manually. We're adding integrations with WebPT, TherapyNotes, AdvancedMD, and other systems so denials can flow in automatically — but those integrations aren't required to use Denial OS today.

Question 12

Is my patient data safe? Is this HIPAA compliant?

Accepted Answer

Yes. We sign a Business Associate Agreement (BAA) with every practice that subscribes — that's the HIPAA contract that defines our responsibilities for handling protected health information. All data is encrypted in transit and at rest. We only use the minimum data necessary (denial codes, claim amounts, provider NPI, patient ID for the letter). We do not store full medical records. We don't sell or share data with third parties.

Question 13

What does the free plan include?

Accepted Answer

One appeal letter per month. You can paste an EOB, get the full letter generated, and download it as a PDF. No fax submission on the free plan — you'd send it yourself. No dashboard or outcome tracking. It's designed to let you see what a Denial OS letter looks like before committing to a subscription.

Question 14

How does the success fee work?

Accepted Answer

On our Practice and Enterprise plans, you can choose to opt in to a success fee instead of using your monthly appeal credits. If you win the appeal and the claim gets paid, we charge 20% of the recovered amount. If you lose, you pay nothing. It's available for claims over $5,000, so it's best suited for your bigger denials where the risk of a 20% fee feels smaller than the risk of leaving thousands on the table.

Question 15

I'm a billing company managing multiple practices. Can I use Denial OS for all of them?

Accepted Answer

Yes. Our Enterprise plan includes white-label options — you can run Denial OS under your own brand for your clients. You get an admin dashboard showing all your practice accounts, consolidated billing, and priority support. First three billing company partners get a 90-day free pilot. Email us directly to set that up.

Question 16

What's the difference between Denial OS and ReimburseOS?

Accepted Answer

ReimburseOS tells you what you should be getting paid — before the claim. It's a rate intelligence platform that helps you verify your contracts, negotiate renewals, and catch payers who are systematically underpaying across your code set.

Denial OS is what you do after a claim comes back wrong. You got denied. Now what? This is the tool for that.

They work together: ReimburseOS tells you the contracted rate, Denial OS puts that rate in your appeal letter.

Question 17

How will I know if my appeal worked?

Accepted Answer

We'll remind you at 14 days, 7 days, and on the response deadline if you haven't heard back. When you receive a response (check in the mail, EFT, or an updated EOB), you come back to Denial OS and mark it as won or lost. You enter the amount paid. We track your recovery rate over time. If a payer never responds, we flag it and help you escalate.

Question 18

What states do you operate in?

Accepted Answer

All 50 states. The payer playbooks are currently strongest for California, but the contracted rate database and letter generation work nationally. State-specific details (commissioner filing, regulatory deadlines) are currently built out for California and being added for Texas, New York, Florida, and Washington. If your state isn't fully supported yet, we generate a federal-level appeal letter that's still highly effective.

Eighteen questions. Plain answers.

You brought a denial.
You're leaving with a letter.