Healthcare Access Rights: Fight Insurance Denials & Medical Billing

Insurance denied your claim? Surprise medical bill? California just banned AI insurance denials. Fight back.

California 2025: AI Insurance Denials BANNED

All denials require human review. UnitedHealth sued for 90% AI error rate. You have new rights.

$88B
Medical debt in US
45%
Bills have errors
70%
Appeal success rate
AI Ban
California 2025

Choose Your Healthcare Issue

Select your specific healthcare problem to understand your rights, appeal options, and potential compensation

Check Your Appeal Success Rate

Enter your insurance denial details to see your chances of overturning it

Insurance Denial Appeal Calculator

Fill in your denial details below

Our AI will analyze your description and guide you through the next steps

California Bans AI Insurance Denials (2025)

Landmark law follows UnitedHealth lawsuits for 90% AI error rate

Your New Rights

  • Right to human review of all denials
  • Insurers must disclose AI use
  • Faster appeal process (30 days max)
  • Penalties for non-compliance

How to Use This Law

  • Request explanation of denial decision
  • Ask if AI was involved in determination
  • Demand human review within 30 days
  • File complaint if rights violated

Common Healthcare Access Issues

Know your protections under federal and state law

Common82% denials overturned

Insurance Coverage Denials

Pre-authorization denied, 'not medically necessary' rejections, AI-powered denials now banned in California.

Common74% disputes succeed

Medical Billing Errors

Duplicate charges, upcoding, unbundling, balance billing violations. 45% of bills contain errors.

FrequentProtected by federal law

Surprise Medical Bills

Out-of-network emergency bills, No Surprises Act protects you from balance billing.

Common24-hour requirement

Prior Authorization Delays

Insurance delays critical treatments. Must decide urgent cases within 24 hours by law.

Your Healthcare Rights (2025)

You HAVE the Right To:

  • Appeal any insurance denial

    Internal appeal (60 days), external review if denied

  • Itemized medical bill

    Request within 30 days of service, must be provided free

  • Good faith estimate

    For uninsured/self-pay, must receive before service (No Surprises Act)

  • Dispute surprise bills

    Out-of-network emergency bills, 30 days to dispute

  • Emergency care without pre-auth

    Cannot be denied for emergency services (EMTALA)

  • Medical records access

    Within 30 days, for $6.50 or less per request

Insurers/Providers CANNOT:

  • Balance bill for emergencies

    Out-of-network ER visits protected (No Surprises Act)

  • Deny without explanation

    Must provide specific reason and medical rationale

  • Charge more than estimate

    Good faith estimate ±$400 or you can dispute

  • Use AI alone to deny (CA)

    California requires human review as of 2025

  • Report to credit during dispute

    No credit reporting during active billing dispute

  • Refuse emergency care

    EMTALA requires emergency stabilization

How to Fight Back: Step-by-Step

Proven strategies with 70%+ success rates

Insurance Denied Your ClaimClick to expand
1.
Get denial in writing - Request formal denial letter with specific reason codes
2.
Review your policy - Check if denial is valid under your coverage terms
3.
Get doctor's support - Request letter of medical necessity from treating physician
4.
File internal appeal - Submit within 180 days with doctor's letter, medical evidence
5.
Request external review - If internal appeal denied, demand independent review (free)
Success Rate: 82% of Medicare prior auth denials overturned (2019-2023). With doctor support, your chances are excellent.
Medical Bill Too High or WrongClick to expand
1.
Request itemized bill - Get detailed breakdown within 30 days
2.
Check for errors - Look for duplicates, wrong procedures, upcoding
3.
Compare to good faith estimate - Bill cannot exceed estimate by >$400
Success Rate: 74% who dispute errors get corrections. Average savings: $1,300 per hospital bill.
Prior Authorization Denied/DelayedClick to expand
1.
Expedited review for urgent care - Request within 24 hours for urgent cases
2.
Peer-to-peer review - Have doctor speak with insurer's medical director
3.
Submit clinical guidelines - Provide evidence-based guidelines
Urgent Care: Must be decided within 24 hours by law.

Real Patients, Real Victories

Healthcare access cases successfully resolved

Appeal Victory
$89,000 Covered

Sarah T. - Cancer Treatment

"UnitedHealth denied my cancer treatment as 'not medically necessary.' Used appeal template, got doctor's letter, external review approved it. Treatment saved my life."

January 2025 • Portland, OR
Billing Dispute
$14,200 Reduced

Marcus J. - Emergency Room

"Out-of-network ER bill for $18,900. Filed No Surprises Act dispute, got it reduced to $4,700 (my in-network copay). Saved $14,200."

December 2024 • Houston, TX
Bad Faith Settlement
$127,000 Settlement

David & Emma K. - Prior Auth

"Insurer delayed surgery approval for 8 months. Condition worsened. Sued for bad faith, settled for $127K (surgery cost + damages)."

November 2024 • Phoenix, AZ

Healthcare Rights in Numbers

Real data from healthcare disputes and appeals

$88B
Medical Debt Crisis
Total US medical debt
45%
Billing Errors
Bills contain mistakes
70%
Appeal Success
With documentation
2025
CA AI Ban
Human review required
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