Appeal Health is developing a service to help hospitals prepare, submit, and track patient-authorized Medicare Advantage appeals.
For hospitals
We’re starting with Medicare Advantage coverage denials during ongoing care. The service is designed to help patients challenge those decisions and help hospitals pursue payment for care.
An appeal asks a health plan to reconsider its decision. Preparing the case takes clinical information, supporting documents, and follow-through.
Hospital teams gather records and respond to denials while patients wait for clarity about coverage. Payment for care can remain unresolved.
With patient authorization, the service is designed to automate appeal preparation, submission, and tracking using your hospital’s denial and clinical information.
OUR INITIAL FOCUS
Our starting point.
We’re focusing first on Medicare Advantage coverage denials during inpatient care.
Member appeals, not provider appeals.
FAST Appeals request urgent review when waiting for a standard decision could seriously harm the patient’s health or ability to regain function.
When the plan must respond.
For qualifying FAST Appeals, the health plan generally must decide within 72 hours of receiving the request.
HOW IT WORKS
Step 1
Patients authorize an appeal
Patients authorize Appeal Health through the hospital to pursue an eligible coverage denial on their behalf.
Step 2
We prepare and submit
Appeal Health uses the hospital’s denial details and clinical information to prepare and submit the appeal to the health plan.
Step 3
Your team follows each case
Hospital teams can track progress and outcomes. Patients receive updates and can access human support.
About us
Add a brief introduction to the team, its experience, and the shared purpose behind Appeal Health.
Founder / CEO
Dr. Gupta brings more than 20 years of clinical experience and expertise in insurance appeals. He previously served as UnitedHealthcare’s National Chief Medical Officer for Network Utilization Management Strategy and Innovation.
COO
Shikha is a strategy and operations leader with a background in consulting and business development. As Managing Director at C Space, she led more than 50 consultants and managed a $25 million client portfolio.
CTO / Product
Julian previously lead a dual role as Head of QA and CX at MulitOn, one of the worlds first AI systems to autonomously control a computer. He pioneered AI evaluation methods, supported enterprise deployments, and helped build a simulated "clone" of the internet, later used by OpenAI and Anthropic.
MTS
George brings more than 13 years of software engineering experience, including seven years leading development of CoPatient’s medical-bill review and negotiation platform. His background spans healthcare software, applied AI, and systems built for HIPAA-regulated environments.
MTS
Jack is a cloud and full-stack engineer with experience building security-focused AWS infrastructure at Ally. He previously led development of a mental health application for the University of Michigan.
Advisor
Mark brings more than 30 years of healthcare IT experience, including nearly 11 years as an IT director at Ascension. His expertise spans electronic health records, health system integrations, and vendor management.
FAQ
What is Appeal Health developing?
Which appeals are you starting with?
Will patients pay for the service?
How can my hospital learn more?
