Upload your Health Insurance Denial

Not transfered to server (stored in your browser)

First name:

Last name:

Your street Address (e.g. 283 24th st)

Not transfered, we do not store (but your phone/computer may store picture)

Scan & OCR your health insurance denial (select all pages)

Transfered to server -- we store*

Your email

Your Insurance Denial & Info Transfered to server -- REMOVE PII FIRST! -- we store for ML + may review

Your insurance denial

Optional: your health history (do not include PII) -- we store for ML + may review

Your Relevant Health History (optional) remove PII first

Optional: plan documents (like summary plan description)

Optional: Plan Documents

Transfered to server, we try not to store outside of session (we do store the state)

Your Zip code

Policies

I am aware that this is for personal use only for those interested in a professional version (doctor/therapist/practioner/office/hospital/etc.) click here to learn more
I have read and understand the privacy policy
I have removed my PII (Personal Identifiable Information) from the text area above
I agree to the terms of service and will only use this website to generate my own health insurance appeals and will not use this website to to treat, diagnose any disease or condition or asist in either of those.
Optional:
Store my raw e-mail to follow up with me (for the duration of automated follow ups + 30 days)*
Increase the number of possible appeals and use external models. This is not required and involves sharing your data with 3rd parties subject to their own TOS potentially including Octoai.

We need your e-mail to proceed, this allows us to delete your data later on request.

Can't proceed as you didn't agree to the terms.

Can't proceed as you didn't check that you had removed your PII from the text area.

* We store a hashed version of your e-mail linked to your (cleaned) denial so you can request removal from our database (should you wish). Coming soon, if you opt-in we will store your raw e-mail to follow up after insurance company timelines may have expired so you can "remind" them. If you opt-in, we may follow up by e-mail after reviewing your denial with a better template if our ML model does not find a good model on the first pass through. You may choose to use a different or temporary e-mail service, like proton mail. Please review our privacy policy for more details