Upload your Health Insurance Denial

First name*

Last name*

Email**

Street Address* (e.g. 283 24th St)

Zip Code (e.g. 94103)

Upload Insurance Denial
Attach all insurance denial pages below:
Once uploaded, your file(s) will populate below in plain text.

Your Insurance Denial
If you are not uploading your health insurance denial file above, please copy and paste your denial below:
(Remove personally identifiable information (PII) as we store for machine learning and may review
OR click the button below to remove name and address from scanned text.)

This scrubbed version of your denial is transferred to our servers.

Policies:

I am aware that this is for personal use only. Click here for those interested in a professional version (doctor/therapist/practitioner/office/hospital).

I have read and understand the privacy policy.

I have removed my personal identifiable information (PII) from the text areas above.

I agree to the terms of service and will only use this website to generate my own health insurance appeals. I will not use this website to treat and diagnose any disease or condition or assist in either of those.

Optional:

Store my email to follow-up with me (for the duration of automated follow ups + 30 days)**

Increase the number of possible appeals and use external models. This is not required and involves sharing your data with 3rd parties subject to their own terms of service potentially including OctoAI, Perplexity, TogetherAI, etc.

Subscribe to our mailing list for updates and news from Fight Health Insurance. We will store your e-mail for this option if selected.

Remember form data - Keep your entered information when navigating back (data stored locally in your browser).
Warning: Uncheck this if using a public or shared computer. Your sensitive information should not be stored on shared devices.

We need your email to proceed, this allows us to delete your data later on request*.

Can't proceed as you didn't agree to all the terms.

Can't proceed as you didn't check that you had removed your personal identifiable information (PII) from the text areas.

We need you to provide your denial message from your insurance company in the text field right underneath the words "Your Insurance Denial" if you didn't get one you can write that you have not received a denial but describe what was denied (for example: The pharmacy said my PrEP was denied). Normally insurance companies are required to provide denials, but in our experience they do not always comply with that.

* We attempt not to store the fields marked with a single asterisk (*) on our server, instead they are stored in your web browser (like a cookie). You can remove this either in your web browser or in our privacy policy page. If you choose to subscribe to the mailing list we will transfer your name and e-mail to the server for subscription.

** We hash your email before storing it in our database, this allows you to request removal from our database (should you wish) without us having to store your raw e-mail. If you opt-in to follow-ups or faxing, we will store your raw email to follow-up after insurance company timelines may have expired so you can "remind" them. If you opt-in, we may follow-up by email after reviewing your denial with a better template if our machine learning model does not find a good model on the first pass-through. You may choose to use a different or temporary email service, like proton mail. Please review our privacy policy for more details. If you choose to subscribe to the mailing list we will transfer your name and e-mail to the server for subscription and it will be stored in a non-hashed format for the mailing list subscription.