The Payer Calls Your Device Investigational. We Write the Appeal From Their Own Policy.
Your market access team knows the policies. The surgeon's office gets the denial and rarely appeals it. We write that appeal from the payer's own current policy text, one letter per payer that denies, re-issued when the policy changes. Start with one denial: payer, code and the denial reason, no patient data. The draft comes back within 24 hours.
See what we read first: coverage maps for CPT 27278, E0483, E0738 and CPT 15011-15018.
- No patient data
- No BAA
- No charge
- No pitch
What We Read Before We Write
Four codes, every payer's current policy, each stance in the payer's own words and linked to its source.
CPT 27278
Minimally invasive SI joint fusion. Most payers deny by device. Checked 2026-10-09.
Read the coverage mapHCPCS E0483
High-frequency chest wall oscillation vest. Covered with criteria; payers split on neuromuscular disease. Checked 2026-10-13.
Read the coverage mapHCPCS E0738
Upper-limb rehabilitation system. Every policy that names it calls it investigational. Checked 2026-10-15.
Read the coverage mapCPT 15011-15018
Autologous skin cell suspension. One payer covers burns with criteria; most call it investigational. Checked 2026-10-22.
Read the coverage map
An "investigational" denial is a position with a text behind it.
The policy, the evidence it cites and the gaps it names. That text is where the appeal starts, and it is the payer's own.
- Where the policy concedes a treatment effect, the letter says so. A denial that rests on evidence gaps is not a denial for absence of benefit, and the letter draws that line.
- The patient is matched to the trial the payer itself cites. Diagnosis, duration, prior therapy and plateau, in brackets the office fills in.
- The FDA authorization goes in. De Novo, PMA or 510(k), as the maker states it.
- The gaps the policy names get a measured answer. One course with objective re-assessment, so the payer gets the member-level data it says is missing.
- The request ladder is built in. Reconsideration, peer-to-peer, benefit exception, external review under state law.
- Every citation is checked. Each cited line is compared with the passage it cites before the letter leaves. A line that does not hold is removed.
3 Steps. No Patient Data.
Here is how the one-denial run works:
- 1Send payer, code and denial reasonThe denial reason as the payer wrote it. No names, no member IDs, no dates of service. The form refuses them.
- 2We draft from the payer's own policyThe version in force on the denial date, the evidence it cites, the gaps it names. Every citation checked against the text.
- 3The office fills in the patient and sendsBrackets for the patient facts. A person at the office approves and sends it on their letterhead. The kit re-issues when the policy changes.
Check the Source Yourself
Open the coverage mapOpen the policy below and read the payer's own sentence.
A payer's stance, as the coverage map carries it
“Fusion of the Sacroiliac Joint ... is unproven and not medically necessary for all other indications and with any other devices not listed above” 1
[1] UnitedHealthcare, Sacroiliac Joint Interventions, 2026T0621O. Effective 09/10/2026. Read it on uhcprovider.com
The letter against this denial starts with the sentence before it: the policy covers the procedure and denies only the device.
Every quote is the payer's. Verbatim, under 30 words, linked to the payer's own document, with the date it took effect.
A named person answers. Malte Wagenbach, Vantar Group LLC, a US company.
Nothing sends itself. A person at the office approves every appeal, and every action is logged.
The first one asks for nothing. No patient data, no BAA, no card, no call.
- Every citation opens
- Nothing sends itself
- Verifiable in two minutes
Which One Are You?
Three ways in. Device makers first.
You Make the Device
Payers call your code investigational and the offices do not appeal. One letter per denying payer, from the payer's own policy, re-issued when it changes.
For device makersYou Bill for Other Practices
The denials your team has no hours for. Start with a free review of one client's denials.
For billing companiesYou Are the Practice
Find out what your write-off pile is worth. One export, one page back.
For practices
Send One Denied Claim. Read What Comes Back.
The appeal, written from that payer's own policy, within 24 hours.
Payer, code and the denial reason. No patient data, so nothing to sign first. If the letter is not better than what the office sends today, you have lost ten minutes and we will say so.
Good Fit, or Not a Fit?
Read this before you send a denial.
Good Fit
- Your device has its own CPT or HCPCS code, or sits next to one.
- Commercial payers call it investigational, unproven or not medically necessary.
- The physician offices that use it get the denials, and the appeals are thin or do not happen.
- Your market access team wants the argument written down once per payer, and kept current.
Not a Fit (Yet)
- You want appeals sent without a person at the office approving them.
- You want us to call payers or patients.
- You want us to hold patient data for the kit. It holds none.
- You need a payer whose policy library is not public. We say so instead of guessing.
Your Questions Answered
What do I need to send for the one-denial run?
The payer, the CPT or HCPCS code, and the denial reason as the payer wrote it. No names, no member IDs, no dates of service. The form refuses them.
Do you need patient data?
No. The appeal kit holds no patient data. The letter carries brackets for the patient facts, and the office fills them in. So there is no BAA to sign for the kit or the one-denial run.
Where does the argument come from?
From the payer's own current policy: where it concedes a treatment effect, the evidence it cites, the gaps it names, and the codes it lists. Each cited line is checked against the passage it cites before the letter leaves. The device's FDA authorization and the trials the policy itself cites go in.
We already subscribe to payer policy alerts. What is different?
An alert tells you the text changed. The kit is the argument against that text, one letter per denying payer, and it is re-issued when the text moves.
Who sends the appeal?
The physician office. A person there approves the letter and sends it on the office's letterhead. Nothing goes to a payer without that approval.
What does it cost?
Start with one denial, free: payer, code and the denial reason, no patient data. The appeal kit has a flat fee, named on the first call. It never depends on what is recovered.
Does the fee depend on approvals or on device volume?
No. The fee is fixed and agreed in writing. It does not depend on an approval, on what is recovered or on how many devices are used, and nothing is paid to a provider.
Do you have every payer's policy?
No. We read the payer's published policy where it is public and say so where it is not. The coverage maps list the payers that could not be verified rather than guess a stance.
Which page is for me?
If you make the device, see for device makers. If you bill for other practices, see for billing companies. If you are the practice, see for practices.
Will you contact our payers or patients?
No. The office approves and sends every appeal, on its own letterhead. We never contact patients.
Who is behind AppealHound?
Vantar Group LLC, a US company in Sheridan, Wyoming. Data is stored in the United States. One person reads every message to malte@appealhound.com.