Tell us what happened. We'll take it from there.

This takes a few minutes. Walk us through the claim your insurer denied or charged you for, and upload your Explanation of Benefits — the document showing what they billed and what they say you owe. From there, we write the appeal, cite the law that backs it, and send it back for you to review. Once you approve the appeals package, we'll submit it on your behalf.

Your Contact Information

First name

Last name

Phone

Your Insurance Information

Insurance company name

Member ID / Subscriber ID

Group Number

Your Claim

Date of service

Description of service or procedure

Denial or cost-sharing reason (as shown on your EOB)

Amount you were charged

Anything else?

Documents

Explanation of Benefits

This is the document your insurer sends after a claim is processed. It shows what was billed, what your insurer paid, and what you owe. Upload the EOB for the service you were charged for.

Additional supporting documents

Upload any bills from your provider, prior authorization letters, or other relevant documents.

Acknowledgements

I confirm that the information I have provided is accurate and complete to the best of my knowledge.

I have read Claimant's Legal Disclaimer and I understand that Claimant is not a law firm and that submitting this form does not create an attorney-client relationship. The appeal materials Claimant generates are not legal advice. I may consult a licensed attorney before sending any appeal letter.

I have read and agree to Claimant's Privacy Policy and Terms of Service.

Claimant collects the information you provide here — including contact details and the health insurance information you choose to share — to prepare your appeal materials and communicate with you about your request. We do not sell your personal information or health data. You can request access to or deletion of your information at any time by emailing hello@claimantinc.com. For more information, see our Privacy Policy and Consumer Health Data Privacy Notice.