⚠️ BETA - USE AT YOUR OWN RISK

Submit Your Insurance Denial

Let AI help you fight back against unfair denials

⏱️ Takes approximately 5 minutes

Patient Info

Insurance

Denial Info

Review

Patient Information

Patient Name *

Email Address *

Phone Number *

Format: (XXX) XXX-XXXX

Insurance Details

Insurance Company *

Policy Number *

Denial Date *

Denial Information

Denial Reason *

Upload Denial Letter (PDF only, max 10MB) *

Click to upload or drag and drop

PDF only (max 10MB)

Review & Submit

Review Your Information

Patient Name

Phone

Insurance Company

Policy Number

Denial Date

Denial Reason

Uploaded Document

I agree to the Terms of Service and Privacy Policy. I understand that this service does not constitute legal advice and is for informational purposes only. *

⚠️ BETA SERVICE - IMPORTANT LEGAL NOTICE

This service is currently in BETA testing. By using this service, you acknowledge and agree to the following:

NO HIPAA COMPLIANCE: You waive all rights to HIPAA compliance and privacy protections for information submitted through this beta service.
NO LIABILITY: You agree that ReclAIm, its founders, employees, and affiliates cannot be held responsible for any damages, losses, or adverse outcomes resulting from use of this service.
NO LEGAL RECOURSE: You waive your right to sue or pursue any legal action against ReclAIm for any reason related to this service.
NOT LEGAL/MEDICAL ADVICE: This service does not constitute legal or medical advice. Consult with licensed professionals for your specific situation.
USE AT YOUR OWN RISK: This is experimental software provided "AS IS" without warranties of any kind.

By submitting this form, you accept full responsibility for all risks associated with using this beta service.