Denial Escalation Navigator: What To Do After Your Appeal Is Denied

Has anyone had any success in fighting an insurance denial for back surgery? I have a medicare

advantage plan. I have been denied lumbar fusion surgery twice by my plan.

“Has anyone had any success in fighting an insurance denial for back surgery? I have a medicare advantage plan. I

have been denied lumbar fusion surgery twice by my plan.” For patients whose health insurance appeal has already

been denied — a decision engine that names your next move, a deadline calculator with red/yellow/green status, 31

worksheets and 9 call scripts to work the escalation properly.

THE PROOF

66% Of the appeals HealthCare.gov consumers filed in 2024, insurers upheld their own denial —

and only 4% of those upheld appeals went on to external review

Source: Source: KFF, Claims Denials and Appeals in ACA Marketplace Plans in 2024 (published March 2026)



WHAT IT SETTLES

Don't stop at the denial. Know your next appeal, your deadline, your evidence, and your escalation path.

In the package: 97 pages · 31 worksheets · 9 call scripts · 6-sheet spreadsheet