Appeal My Claim

{'type': 'object', 'required': [], 'properties': {'date': {'type': 'string', 'description': 'Date of service.'}, 'name': {'type': 'string', 'description': "Member's name."}, 'plan': {'type': 'string', 'description': 'Insurer or plan name.'}, 'claim': {'type': 'string', 'description': 'Claim or reference number.'}, 'doctor': {'type': 'string', 'description': "Treating doctor's name."}, 'reason': {'enum': ['medical_necessity', 'emergency', 'experimental', 'out_of_network', 'prior_auth', 'coding', 'generic'], 'type': 'string', 'description': "Why the claim was denied: medical_necessity, emergency (said it wasn't an emergency), experimental, out_of_network, prior_auth, coding or generic. Required unless denial_code is given."}, 'urgent': {'enum': ['yes', 'no'], 'type': 'string', 'description': 'Set to yes to ask for an expedited review.'}, 'details': {'type': 'string', 'description': "A sentence or two in the user's words on why the care should be covered."}, 'service': {'type': 'string', 'description': 'The care that was denied, like "MRI of the right knee".'}, 'provider': {'type': 'string', 'description': 'Hospital, clinic or provider name.'}, 'member_id': {'type': 'string', 'description': 'Member ID or Medicare number.'}, 'plan_type': {'type': 'string', 'description': 'Same values as plan_type in get_appeal_rights. Changes the wording for Medicare.'}, 'denial_code': {'type': 'string', 'description': 'The reason code on the notice, like CO-50 or PR-197. Picks the reason when reason is left out, and is quoted in the letter.'}, 'denial_date': {'type': 'string', 'description': 'Date on the denial notice.'}}, 'additionalProperties': False}

{'type': 'object', 'required': ['code'], 'properties': {'code': {'type': 'string', 'description': 'One to four codes from the notice, like CO-50, PR 204, 197 or N130.'}, 'plan_type': {'type': 'string', 'description': 'Same values as plan_type in get_appeal_rights. Carried into the letter link.'}}, 'additionalProperties': False}

{'type': 'object', 'required': [], 'properties': {'urgent': {'enum': ['yes', 'no'], 'type': 'string', 'description': "Set to yes if waiting could seriously harm the person's health."}, 'plan_type': {'type': 'string', 'description': 'Same values as plan_type in get_appeal_rights. Default: most private plans.'}, 'denial_date': {'type': 'string', 'description': 'Date on the denial notice, like 2026-09-01, 09/01/2026 or September 1, 2026.'}}, 'additionalProperties': False}

{'type': 'object', 'required': [], 'properties': {'state': {'type': 'string', 'description': 'US state name or two-letter code, like California or CA. Puerto Rico works too.'}, 'plan_type': {'type': 'string', 'description': 'Plan type: marketplace, employer, employer_insured, employer_self_funded, medicare, medicare_advantage, part_d or medicaid. Everyday words work too, like "job", "Obamacare" or "Medi-Cal". Default: most private plans.'}}, 'additionalProperties': False}