You Can Appeal. Most People Don't. But It Works Often.

How I beat an insurance denial for my dad's hip replacement using the same document capability we are now putting in everyone's hands with Available Health.

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I started Available Health because I needed a tool to manage my dad's healthcare. Over the last year and a half, I have watched the healthcare system fail him when he needed it most.

When normal people think about healthcare, they think about going to the doctor and going to the pharmacy. They might think about operations, and everyone knows insurance is expensive. What they do not think about are the boundaries and edge cases between all of those things, and how consequential they can be.

Healthcare today: patients are on their own

My dad's family doctor would not take action after my dad came in repeatedly for shoulder and hip pain. When specialists finally got involved, they did not communicate well because their health systems used different EHR vendors: Epic and Oracle Health, formerly Cerner.

Things got missed, and a proper diagnosis took longer, which meant more time he spent in pain and unable to do the things he enjoyed. Nobody was coordinating his care as a team, which is common in healthcare today. The gaps that follow force patients and their families to become their own care coordinators.

UnitedHealthcare is issuing immediate, unintelligible denials to legitimate claims

Once we knew he needed a hip replacement to feel better, UnitedHealthcare rejected the surgeon's request for prior authorization. The rejection came back almost immediately, with an incoherent explanation, and that meant we had to appeal.

"The records from your provider do not show: Your x-rays show very serious problems with your hip joint. Your provider has sent us copies of your x-ray reports."

I had never done that before, but by then I already had all of his records and Available Health was operational. I uploaded the rejection document and asked it to draft an appeal. The output was a concise one-page letter that cited key facts from 60 pages of medical records.

This is why Available Health is so effective at appeals: it knows your entire health history. It had every visit, every non-operative treatment he tried, and the full length and volume of his complaints, all documented by his doctors and all showing how much the pain was limiting his life.

Distilling that into a succinct summary was critical. Then I had to fax it in. Yes, fax. I also looped in his orthopedist so the provider could file an appeal at the same time.

Appeals can come from members and doctors

Here is what most people do not realize: you can appeal an insurance denial yourself. Both members and providers are allowed to file, and you do not have to wait on your doctor to do it. Filing your own appeal alongside the provider's gives the case two independent pushes through a process that is built to stall, and it works far more often than people expect.

In Medicare Advantage, more than 80% of denied prior authorization requests that were appealed in 2024 were overturned, yet only about 11% of denials were ever appealed at all.[1]

And that snapshot likely understates where things are headed: as insurers adopt AI to automate utilization review, denials are only ramping up, with 61% of physicians reporting in a 2025 survey that health plans' use of unregulated AI is increasing prior authorization denials.[2]

The system is betting you will not push back.

A 30-day delay in getting a treatment scheduled because of a mistaken insurance denial may not sound like much, until you are in a lot of pain. Then 30 days feels like a very long time.

In the weeks leading up to the decision, I called for status updates over and over and got a different answer every time. Some reps sounded sympathetic. Others urged me to stop calling. I kept my head through the barrage of apathy and incompetence.

After 27 days, we checked the portal and found the denial had been overturned.

It worked.

Why we built this

Whenever something goes wrong in healthcare, it becomes a job. Somebody has to take it on, gather the records, make the calls, hold people accountable, and manage it to a conclusion. Years of working in healthcare taught me how to do that. Most people have no reason to know how, and they should not have to.

That is why we are introducing a document capability in the Available Health agent. The agent could already read your documents. Now it can create them too, and it can collate an entire packet from your source materials, whether you are appealing an insurance denial or disputing a medical bill.

It pulls the relevant facts from your records and assembles everything you need to make your case, so you do not have to do it alone.