How it works

1. 1

   Upload the notice or the pharmacy hand-out

   Free

   Take a photo or upload the PDF of the pharmacy notice, the plan's written denial, the redetermination decision, the IRE decision, or a pharmacy receipt. We read it and tell you what it is, who sent it, what drug was denied, and the date that starts your clock.

2. 2

   Get the explanation

   Free

   In plain language: what happened, why the plan says it denied it, what Medicare's own Part D rule says about that kind of denial — with a link on every claim so you can check it yourselfrule42 CFR 423.578, and how long you have. If it's a pharmacy notice, we tell you to ask for a coverage determination, not to file an appeal — those are different steps with different clocks.

3. 3

   See both clocks

   Free

   Your deadline to ask for a redetermination (65 days from the date on the plan's denial notice)rule42 CFR 423.582, and the plan's own deadline to decide once you've asked (7 calendar days, 14 for a payment request, 72 hours if expedited)rule42 CFR 423.590. If the plan misses its clock, that silence itself counts as a denial and the plan must forward your case to the Independent Review Entityrule42 CFR 423.590 — we tell you the day it happens. Reminders by email so nothing slips.

4. 4

   Fight it — Appeals Plus

   $39, per case

   We write the request first and show you the preview. If we can't write it, you're never asked to pay. This is the appeal packet:

   1. The redetermination or exception request, argued from the rule the plan is bound by, with a footnote on every point a plan reviewer can check.
   2. The letter for your prescriber — one page that tells the office exactly what a supporting statement needs to address, with your deadline on it.
   3. The filled Model Coverage Determination Request Form and Model Redetermination Request Form, and the Appointment of Representative form (CMS-1696), so you can act for your parent.
   4. Every follow-up letter as the case moves: the IRE reconsideration request if the plan says no again, and the request for a judge's hearing if it goes that far.
   5. Your information stays yours. Your parent's name, Medicare number, and address go into the letter when you download it and are not stored by us.
5. 5

   Keep going until it's done

   Free

   Upload each decision as it arrives and the case moves to the next level with a new deadline and a new letter. If the plan won't answer, if the drug is statutorily excluded and no appeal can win, or if you missed the window, the case page tells you exactly who to call and what to say. One payment covers this case at every level for 12 months.

What $39 is compared to

Prices for other services as observed September 2026.

Then we keep track of it

Every step, every form, every date, in one place — free, for as long as the case takes.

Why not free?

The explanation is free because you shouldn't have to trust us before you've seen that we read your notice correctly. The packet costs money because it costs us money to build and keep current — the rules, the formulary exceptions process, and the deadlines change, and every citation in your letter is checked against the current text the day you generate it.

Questions people ask

What if you can't write my letter?

Then there's nothing to pay for. We prepare your letter first and show you the preview; the $39 unlocks the download. You see your letter before you pay.

What if we lose?

No refunds based on outcome — we can't promise a result, and we don't. What we promise is that your letter argues from the rule and arrives on time.

Is this legal advice?

No. CaseWhy Appeals explains the rules and prepares documents; it isn't a law firm and doesn't replace one. When a lawyer helps, we say so.

Do you send the request for me?

Not yet. The letter tells you where and how to send it; most plans accept fax, mail, or their member portal.

Is Plus a subscription?

No. Plus is a single, one-time payment of $39 per case — nothing renews or recurs, and no further charge follows for that case. It covers every letter and every appeal level for 12 months.