Every year, 262 billion dollars in healthcare claims get denied. Most of those denials are wrong. And almost nobody fights them.
This isn't a story about insurance. It's a story about an office manager named Sarah who has a stack of unfought paperwork on her desk and forty-seven other things to do today. We built Denial OS because the tool she needed didn't exist — and the people building everything else weren't going to build it for her.
Sarah Chen has 14 denials on her desk.
She's 34. She runs the front office at Sunrise Physical Therapy in Sacramento — three providers, mostly commercial insurance, the kind of clinic you find in every American suburb. She handles billing, scheduling, intake, referrals, payroll, and whatever else lands on her desk. She picks the tools. The doctors don't want to hear about it.
Last Tuesday at 2:47 PM, she logged into the Anthem provider portal to check on a $1,800 claim for four units of CPT 97110 for a patient seen on April 12. The EOB came back: paid $0. Denial code CO-97— “bundled with another service.” She has fourteen other denials in the stack right now. Three from Anthem. Two from Blue Shield CA. Four from Aetna. Two from UHC. One from Cigna. Two from BCBS Texas (a snowbird patient). $38,400 sitting uncontested.
She submitted exactly one appeal last year. It took six hours. She never heard back.
She is the customer. Every screen, every email, every dollar amount on a card — written for her. Sarah is not impressed by features. She is impressed by the moment a check shows up.
This isn't a rare problem. It's the default.
The appeal process was designed to make providers quit. Three-page fax forms. Payer portals that time out. Deadlines buried in 90-page provider manuals. Reason codes that mean nothing without a codebook.
The average office manager has 47 other things to do today and exactly zero tools that speak insurance company. So the stack on her desk gets taller. The dollars get written off. The payer wins by attrition.
The numbers we trusted. (And you can verify.)
Three primary-source documents you can read tonight. Every claim on this page traces back to one of them.
- KFF
"Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023"
January 28, 20253.2M prior-auth denials in 2023 (up from 2M in 2019). 80%+ of appealed MA denials are overturned. The denial volume + overturn-rate-on-appeal data.
- CMS
Transparency in Coverage Final Rule (45 CFR §147.211)
Finalized November 12, 2020 · enforcement July 2022 → January 2023The legal basis for the contracted-rate paragraph we cite in every letter. Before this rule, this information was effectively private.
- U.S. Senate PSI
"Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Critical Care"
October 17, 2024The bipartisan staff report on UHC, Humana, and CVS Aetna algorithmic denial patterns. Public, paginated, and damning.
We cite their own contract back at them.
Since 2022, every commercial payer has to publish their negotiated rates by law. ReimburseOS already parsed all of them. Denial OS turns that data into a sentence the payer cannot argue with: the dollar figure they themselves committed to in writing.
No competitor can write that sentence without rebuilding our entire parsing infrastructure. That work took years. They're welcome to start now.
Per Anthem Blue Cross of California's Transparency in Coverage machine-readable file effective April 1, 2026, the contracted in-network rate for CPT 97110 in the State of California is $94.20 per unit. The submitted claim of $1,800.00 for 4 units should have resulted in payment of $376.80.
The actual payment of $0.00 falls $376.80 (100.0%) below the rate to which Anthem Blue Cross is contractually obligated under our in-network provider agreement. We respectfully demand correction of this payment, plus any applicable interest under California Insurance Code §10123.13.
Why this product, in 2026, can be built and won.
- 1
The MRF data exists for the first time in history
CMS Transparency in Coverage Rule (45 CFR §147.211) — finalized 2020, enforced July 2022. Anthem, Aetna, UHC, Cigna, Humana, BCBS plans now publish negotiated rates as a legal matter. Before 2022, this was structurally private.
- 2
AI letter quality crossed the credibility threshold in 2025
Claude Opus 4.7 produces appeals that pass blinded comparison with healthcare-attorney-drafted letters when grounded in playbook + denial-code library + contracted rate. EvenUp ($350M Series E) proved AI demand letters are billable. We are post-flip.
- 3
The Medicare Advantage denial surge made it public
KFF January 2025 report. Senate PSI October 2024 staff report on algorithmic denials at UHC / Humana / CVS Aetna. WSJ ‘Reject’ series, STAT News ‘Denied by AI.’ The public is primed. The regulators are watching.
- 4
CMS-0057-F prior-auth rule went live in 2026
Effective January 2026: 7-day standard responses, 72-hour expedited, written denial reasons required, payers must publish PA approval/denial metrics. Every written denial reason is a paper trail Denial OS weaponizes.
- 5
SMB practice pain is at a record high
MGMA 2024 DataDive: denial rates 11.2% (up from 9.8% in 2022). Days-in-A/R 41.3. 65% of independent practices report denial backlogs of 30+ days; 23% report 90+. Office managers are the bottleneck — and they’re drowning.
- Five forces. One window.
Twenty-four-month head start on a market that's actively boiling. The contracted-rate paragraph alone is the moat.
The second half of a longer mission.
Predicts the contracted rate before the claim.
Built on the same TiC MRF parsing infrastructure that now powers Denial OS. Twin Flame customers already know what they should be paid.
Recovers the contracted rate after the denial.
Inherits the rate database. Adds payer playbooks, deadline tracking, fax submission, and commissioner escalation. Every ReimburseOS customer is a warm Denial OS customer. Zero cold acquisition cost on the core ICP.
Together, they own the full insurance revenue cycle. The data infrastructure was already built. Denial OS is the second half.
“I built TwinFlame because the platforms I knew should exist — for the people I knew personally — were never going to come from anyone else.”— David Hitchman, founder
Every build at Twin Flame Group serves a specific human David knows by name. Sarah is one of them. The quality of the build is the respect for her. When in doubt, the side that better serves a specific person David knows always wins.
If you're reading this as a possible partner.
Whether you run a billing company, a practice-management platform, an investor fund, or you just know someone who should see this — the door is open. Two ways in:
Book 30 minutes with David
Direct line to the founder. He answers his own email. david@twinflamegroup.com
Send the noteSee the product live
The 90-second user journey: paste an EOB, watch the letter write itself, send it.
Watch the demoDenial OS is a Twin Flame Group product. Sister to ReimburseOS. Built out of Sacramento, California — within driving distance of Sarah's office.