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DENIALOVERTURN.COM
Appeals, automated.
Every patient can fight a denied health-insurance claim — starting with the 72-hour Medicare Advantage discharge crisis.
Seed round  ·  May 2026  ·  working title
The Problem

Denials are everywhere.
Appeals are almost nowhere.

~17%
of in-network ACA claims are denied
<0.2%
of patients ever appeal a denial
80–90%
of filed appeals are overturned
3×
rise in MA post-acute denials since 2019

A 400× gap between how often patients win and how often they try. The work — deadlines, claim-file requests, medical-policy citations, appeal letters — lands on patients during a health crisis, so almost no one does it.

Overturn  ·  Confidential  ·  working title
2
Why Now

Three forces just made this solvable

1

Denial algorithms created patterns

nH Predict, PXDX, and EviCore turned denials into predictable, attackable templates we can classify and rebut at scale.

2

Regulators are forcing the issue

The 2024 Senate investigation and 2025 CMS rule changes standardized notices and put insurers on the defensive.

3

LLMs make appeals cheap

What used to take an advocate hours — drafting a cited appeal — now costs cents per case, so the unit economics finally work.

Overturn  ·  Confidential  ·  working title
3
The Solution

What a hospital billing office does — in an app

Step 1

Capture

Photo, PDF, or email-forward the denial letter.

Step 2

Classify

Identify denial type and surface procedural defects.

Step 3

Compose

Draft a citation-backed appeal in the right template.

Step 4

File

Submit through the right channel — fax, portal, or QIO.

Step 5

Track

Watch every deadline; escalate if denied again.

Powered by a proprietary, outcome-labeled denial corpus and a classifier + template library that improve with every case.

Overturn  ·  Confidential  ·  working title
4
Beachhead

Start where the pain is sharpest: MA post-acute

The 72-hour crisis

  • A caregiver gets a discharge notice (NOMNC) for a parent in rehab.
  • They have 72 hours to appeal to an independent Medicare reviewer.
  • Over 90% of those appeals win — and coverage continues during review.
  • Today there is no integrated tool to help them. Almost no one appeals.
>90%
reversal rate when these appeals are filed
$0
cost to the family to file
72 hrs
decision window — highest urgency wedge
High
willingness to pay in the moment
Overturn  ·  Confidential  ·  working title
5
Market

A multi-million-claim wedge with large adjacencies

50M+
denied U.S. health claims every year (TAM)
Tens of M
denied claims in Medicare Advantage alone (SAM)
100K
MA post-acute appeals as the beachhead (SOM)
Expansion path
  • Commercial & ACA medical-necessity and experimental denials
  • Medicaid managed care + pediatric EPSDT
  • Mental-health parity (MHPAEA) denials
Overturn  ·  Confidential  ·  working title
6
Business Model

Per-appeal pricing with healthy margins

$149–249
per appeal (standard / MA-urgent)
~81%
contribution margin per case
~$100
profit per customer after acquisition
$45
blended customer acquisition cost
Later layers
  • Subscription for chronic-condition households
  • B2B SaaS for patient advocates and provider billing offices

Modeled on conservative funnel and pricing assumptions; contingency and subscription compared in the financial model.

Overturn  ·  Confidential  ·  working title
7
Financial Snapshot

Revenue ramp on the flat-fee model

604,776
Year 1
2,356,194
Year 2
9,179,675
Year 3
$12.1M
cumulative 3-year revenue (flat-fee)
+$2.2M
cumulative operating profit by month 36

Year-1 burn ≈ $382K, then profitable as volume ramps. All figures are model assumptions — see the financial model.

Overturn  ·  Confidential  ·  working title
8
Go-to-Market & Moat

Win the wedge, compound the data

1

6-month MVP

Ship the MA post-acute flow end to end.

2

Pilot 3 states

California, New York, Michigan — strong external-review programs.

3

Prove the lift

Target ≥1.5× overturn rate vs. unaided appeals on the first 100 cases.

4

Compound the moat

Each case enriches an outcome-labeled corpus + template library.

Overturn  ·  Confidential  ·  working title
9
Why We Win

Positioned between DIY and done-for-you

DIY / generic AI Patient advocates / attorneys Overturn
Speed in a 72-hr crisis Variable Slow / scheduling Minutes
Cost Low $$$ hourly / contingency Flat per-appeal
Denial-specific expertise Generic High High + automated
Deadline & escalation tracking None Manual Built-in
Scales to millions of cases No No Yes
Overturn  ·  Confidential  ·  working title
10
The Ask

Raising a seed round to ship the MVP
and prove the unit economics

$2.0M
target raise (placeholder)
33 mo
runway (conservative)
~20%
new-investor ownership at $8M pre
Use of funds
  • Engineering & product 45%
  • Customer acquisition 25%
  • Compliance & legal 15%  ·  Operations & G&A 15%
Figures are placeholders — tune in the financial model's Cap Table & Fundraise tab.
Team & Contact

Built by people who have lived this problem

  • Mark J. Lowry — AI Engineer with over 20+ years in tech. Created and sold numerous businesses and system designs.
  • Brian Beasley — ML / healthcare data experience.
  • Dr. Gary Gates — regulatory and appeals expertise.
DENIALOVERTURN.COM
Appeals, automated.  ·  [email]  ·  [website]  ·  working title
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