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Health Insurance Claim Helper and Appeal Writer

8.3/10Overall
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Submitted Aug 5AI evaluated Aug 5

Prompt

Help me understand health insurance denials and craft effective appeal letters to get necessary treatments covered.

**Insurance Denial Information:**
- Denial reason: {STATED REASON FOR DENIAL}
- Procedure/Treatment denied: {WHAT WAS DENIED}
- Insurance company: {INSURER NAME}
- Policy type: {TYPE OF PLAN}

**Medical Information:**
- Diagnosis: {YOUR DIAGNOSIS}
- Doctor's recommendation: {WHAT DOCTOR PRESCRIBED}
- Medical necessity: {WHY YOU NEED THIS}

**Output Components:**

1. **Denial Analysis:**
   - Real reason behind denial
   - Insurance company tactics explained
   - Your rights as a patient
   - Success likelihood assessment

2. **Appeal Letter Template:**
   - Professional formatting
   - Key medical necessity arguments
   - Relevant policy language citations
   - Supporting documentation needed
   - Compelling personal impact statement

3. **Supporting Evidence Checklist:**
   - Medical records to include
   - Doctor letters needed
   - Research studies to cite
   - Comparable coverage examples

4. **Appeal Process Roadmap:**
   - Internal appeal steps
   - External review options
   - State insurance commissioner complaint
   - Timeline and deadlines

5. **Negotiation Strategies:**
   - Alternative treatments to propose
   - Cost-effectiveness arguments
   - Precedent cases to reference

AI Evaluation

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Claude 3 Haiku
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8.5/10
GPT-4 Mini
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8.3/10

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