DenialHelp for Partners
Patient-paid AI appeals infrastructure for the procedures, devices, and diagnostics that fall outside pharmacy benefits ePA networks. For early conversations with patient-access, market-access, and commercial leadership at specialty manufacturers.
The problem
Roughly one in eight commercially insured prescriptions are denied on first submission, and roughly half of denied patients never appeal. For specialty drugs, durable medical equipment, structural cardiology, advanced diagnostics, and rare-disease therapies the denial-to-abandonment funnel is the single largest leak between prescription and dispense.
Existing hub-services partners cover pharmacy ePA submission but stop short of the medical-necessity appeal narrative — the artifact that determines overturn rates on internal review, external review, and state-mandated arbitration.
What DenialHelp does
- AI-drafted appeals across ~90 clinical verticals / ~1,580 treatments. Frontier model (Claude Sonnet 4.5) via the Anthropic subscription Claude CLI over de-identified inputs (PHI redacted in-house), under signed BAA.
- Bundled PDF packet — cover sheet, narrative appeal letter, OCR'd supporting documents with bookmarks. Single deliverable the patient or prescriber mails/faxes/portals.
- Patient-direct intake. No EHR integration required. Works from any portal, any payer, any state.
- Pro-tier prescriber product (launched 2026-05-22): prescriber-signed narrative attachment for prior authorization. Same drug-agnostic breadth.
Engagement structure
Sponsorship engagements use the Personal Services Safe Harbor (42 CFR § 1001.952(d)). Flat per-case fee or annual subscription; the appeal output is provably independent of funding source via audit-logged, deterministic recommendation hashing (mitigation pattern for OIG AO 22-19). Drug-agnostic appeal logic is contractually warranted and externally auditable.
- Written agreement with FMV-justified compensation set in advance
- Eligibility independent of patient's therapy choice
- Patient consent flow disclosing sponsorship before generation
- De-identified aggregate outcome reporting; no PHI flows back to sponsor
- Right of audit by sponsor's independent compliance counsel
Compliance posture
- HIPAA BAA in place with AWS, Google Workspace, and Paubox
- SOC 2 Type I engagement in progress (2026)
- Privacy Officer: Michael John Ryan (founder)
- HIPAA Security Rule controls documented; audit log retention 6+ years
- Encryption at rest (LUKS) + in transit (TLS-enforced)
- RFC 8058 one-click unsubscribe across all outbound email
Where DenialHelp fits
Specialty pharma in oncology, rare disease, cardiology, and CNS. Medical devices in diabetes (pumps + CGMs), neurostimulation, structural cardiology. Diagnostics in oncology and rare disease. Niche: anything outside the pharmacy-benefit ePA networks where denial narrative materially drives access.
Start a conversation
Email partners@denialhelp.com for an initial discovery call. Please include:
- Your role and the product/therapy area you support
- Approximate denial volume or pain points you're seeing
- Any compliance/legal counsel you'd want present on a follow-up
DenialHelp, LLC — Delaware C-corp — 1111B S Governors Ave # 50985, Dover DE 19904 — EIN 36-5178090