Assessment Fee $99
Cases requiring review and analysis are subject to a $99 Assessment Fee. This allows us to evaluate the dispute and determine the best course of action before proceeding.
The assessment may include review of EOBs/ERAs, payer letters, provider-payer correspondence, prior appeal submissions and responses (if any), plan documents (if available), and any other relevant materials needed to understand the issue and identify the payer's underlying tactic.
The process ensures that any recommended strategy or next steps are based on a clear understanding of the dispute, not assumptions or guesswork. As part of this process, we will also let you know if the issue is not worth pursuing. In some cases, the denial, underpayment, or recoupment may be supported by applicable rules, or the cost of pursuing the matter may outweigh the potential recovery. Our goal is to ensure that you have a clear understanding of the situation so you can make an informed decision before moving forward.
Dispute Analysis and Strategy Development
Every case is different. Pricing is based on the complexity, scope, value, and strategic level required for each appeal/dispute letter.
Every case starts with identifying what's actually happening. We analyze the claim dispute, review the available information, and determine the payer's underlying tactic, not just the surface-level denial reason. From there, we build a targeted strategy designed to challenge that tactic using the appropriate plan terms, policy provisions, and regulatory framework.
This process is what drives the appeal, not guesswork, not templates, but a structured approach built around the specifics of your case. You're not paying for a template or a generic appeal. You're paying for a tactically-driven strategy built around your specific claim dispute.
Standard Cases $250 - $350
For straightforward denials, underpayments, or refund demands involving a clearly defined problem. Includes:
- Dispute analysis
- Identification of the payer's tactic
- Strategy development
- Targeted appeal draft
Complex Cases $350 - $750
For multi-issue denials, underpayments, or refund demands, recurring problems, or cases requiring deeper review of plan terms, policies, payment methodology, or how governing regulations may assist in recovery. Includes:
- Expanded case analysis
- Strategy built around applicable rules and plan provisions
- Targeted appeal draft with supporting arguments
- Next-step guidance
High-Value / Advanced Cases $750 - $1,000+
+ 5% - 10% recovery fee (when applicable)
For high-dollar claims or refund demands, multiple claims, or situations involving complex payer tactics and escalation strategy. Includes:
- In-depth strategy development
- Advanced appeal drafting based on regulatory positioning
- Escalation and follow-up strategy
- Ongoing direction for next steps
Follow-Up & Additional Letters
Not all follow-up letters are the same. Some involve simple continuation, while others require analysis and strategy based on new information obtained during the dispute process.
Simple Follow-Up $75 - $150
For:
- Brief responses
- Clarifications
- Procedural and administrative replies
- Light continuation of an existing strategy
Strategic Follow-Up / Escalation $150 - $350+
For:
- Situation where plan documents or new information are obtained
- Reframing the dispute based on the payer's position
- Applying regulatory or plan-based leverage
- Escalation or advanced dispute strategy
Why Our Pricing Is This Way
Most appeal services focus on writing letters. We focus on building dispute strategies that evolve as the payer reveals their position. That difference is what changes outcomes.
What This Is Not
- Not template-based appeals
- Not generic arguments
- Not billing or coding corrections
- Not a one-size-fits-all approach
What You're Getting
- A targeted strategy built around your specific claim dispute
- The right arguments based on governing rules
- The ability to adjust strategy as new information emerges
- A clear path forward, not guesswork
- A finished appeal you can submit with confidence
Not Sure Where Your Case Fits
That's normal. Submit a brief overview of your situation with all relevant material, and we'll let you know:
- If it's worth pursuing
- What level of strategy is required
- What the cost will be before any work begins
Final Thought
Most providers submit an appeal and hope for the best. We build structured dispute strategies that adapt, respond, and escalate to challenge payer tactics the right way.
Start with a case review and take the guesswork out of it.
