Terms of Service

3.1 No attorney-client relationship. No use of the Service creates an attorney-client relationship between you and AppealIt or any of its employees, contractors, or affiliates.

3.2 Legal information only. The Service provides general legal and regulatory information -- including citations to statutes, regulations, and coverage standards -- as a convenience to help you understand the appeal process. This is legal information, not legal advice tailored to your specific circumstances.

3.3 You submit your own appeal. You are the submitter of your appeal. AppealIt drafts; you review, revise, sign, and submit. This structure is intentional: the Service is a consumer self-help tool, not a legal service provider. You are exercising your own right under applicable law to appeal your insurer's decision.

3.4 Consult an attorney. If you have questions about your specific legal rights, the enforceability of any provision of your health plan, or whether any aspect of your denial raises legal claims, you should consult a licensed attorney. Organizations such as state insurance departments, patient advocacy nonprofits, and legal aid societies may provide free or low-cost assistance.

3.5 Not a substitute for licensed professionals. Nothing in the Service is a substitute for the advice of a licensed attorney, licensed health insurance advisor, or licensed medical professional.

4.1 AppealIt is not a medical practice and does not provide medical advice, diagnosis, or treatment recommendations.

4.2 Clinical guidelines, medical necessity criteria, and drug/treatment information referenced in generated documents are included for informational purposes to support your appeal narrative. They are not medical recommendations for your individual health situation.

4.3 Consult your physician or qualified healthcare provider regarding any medical decisions. Do not delay or disregard medical advice because of anything generated by the Service.

5.1 No guarantee of appeal success. AppealIt makes no representation, warranty, or guarantee that any appeal drafted using the Service will be approved by your insurer, any internal review body, or any external review organization.

5.2 Insurer decisions are independent. Coverage decisions are made solely by your health plan and, for external review, by independent review organizations. AppealIt has no control over and no relationship with those entities.

5.3 Results vary. Appeal outcomes depend on your specific plan terms, medical circumstances, applicable state and federal law, insurer practices, and many other factors outside our control.

5.4 Past results not indicative. Any statistics or outcomes data we publish (e.g., "X% of appeals succeed") reflect historical aggregate data, not predictions for your individual appeal.

6.1 Provide accurate information. You represent that all information you submit -- including your denial details, diagnosis, treatment information, and plan information -- is accurate, complete, and truthful to the best of your knowledge.

6.2 Review all generated content. You are responsible for reviewing every draft the Service generates before submitting it. You must correct any errors, inaccuracies, or inapplicable content.

6.3 Verify citations. Although the Service is designed to cite verifiable sources (clinical guidelines, regulations, payer policies), you are responsible for verifying that any citation in your draft is accurate and applicable to your situation before submitting.

6.4 Make your own submission. You are responsible for submitting your appeal to the correct recipient (insurer, external review organization, or other) within applicable deadlines. AppealIt does not submit appeals on your behalf and is not responsible for missed deadlines.

6.5 Comply with applicable law. You agree to use the Service only for lawful purposes and in compliance with all applicable federal, state, and local laws.

7.1 Use the Service to generate content you know to be false or fraudulent, including fabricating medical records, diagnoses, physician statements, or payer communications.

7.2 Use the Service on behalf of another person without that person's explicit, informed authorization.

7.3 Use the Service for any commercial purpose, including on a fee-for-service basis as a paralegal, case manager, consultant, or intermediary -- unless you have entered into a separate written agreement with AppealIt for that use.

7.4 Reverse engineer, scrape, or systematically extract content or data from the Service.

7.5 Attempt to circumvent any security measure, rate limit, or access control of the Service.

7.6 Upload to the Service any content that infringes third-party intellectual property rights or that violates any law.

8.1 Privacy Policy governs. Your use of the Service is subject to our Privacy Policy, incorporated herein by reference, which describes how we collect, use, and protect your information.

8.2 Sensitive health information. You will necessarily share information about your health, diagnosis, and insurance coverage to use the Service. We treat this information with heightened care as described in our Privacy Policy.

8.3 Not a HIPAA Covered Entity or Business Associate. AppealIt is not a HIPAA-covered entity. You are using AppealIt as a consumer self-help tool, not as a healthcare provider or health plan, and AppealIt is not acting as a business associate to any covered entity in connection with your personal use of the Service. Your submission of health information to the Service is a voluntary consumer transaction governed by our Privacy Policy and applicable consumer protection law.

8.4 Security breach notification. In the event of a breach involving unsecured health information, AppealIt will provide notifications as required by applicable law, including the FTC Health Breach Notification Rule, 16 C.F.R. Part 318, to the extent applicable.

8.5 Minimization. We encourage you to share only the information necessary to generate your appeal. Do not submit Social Security numbers or financial account numbers through the Service.

9.1 AppealIt IP. The Service, including its underlying software, AI models, prompts, interface design, and all AppealIt-owned content, is owned by AppealIt and protected by applicable intellectual property law. You receive a limited, non-exclusive, non-transferable, revocable license to use the Service for personal, non-commercial purposes in accordance with these Terms.

9.2 Your content. You retain ownership of the information and documents you submit to the Service. By submitting content, you grant AppealIt a limited license to process, store, and use that content to deliver the Service to you and to improve the Service (in de-identified or aggregated form), consistent with our Privacy Policy.

9.3 Generated documents. Appeal letters generated by the Service incorporating your personal information are provided to you for your use. You may modify and submit them freely.

11.1 Exclusion of consequential damages. IN NO EVENT WILL APPEALIT, ITS OFFICERS, DIRECTORS, EMPLOYEES, CONTRACTORS, OR AFFILIATES BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, EXEMPLARY, OR PUNITIVE DAMAGES, INCLUDING LOST PROFITS, LOST DATA, LOSS OF GOODWILL, DENIAL OF INSURANCE COVERAGE, MEDICAL EXPENSES INCURRED FOLLOWING A COVERAGE DENIAL, OR COSTS OF SUBSTITUTE SERVICES, ARISING OUT OF OR RELATED TO YOUR USE OF OR INABILITY TO USE THE SERVICE, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

11.2 Cap on direct damages. IN NO EVENT WILL APPEALIT'S AGGREGATE LIABILITY TO YOU FOR ALL DIRECT DAMAGES ARISING OUT OF OR RELATED TO THESE TERMS OR THE SERVICE EXCEED THE GREATER OF (A) THE TOTAL AMOUNT YOU PAID APPEALIT IN THE TWELVE MONTHS PRECEDING THE CLAIM, OR (B) ONE HUNDRED DOLLARS ($100.00).

11.3 Basis of the bargain. The limitations in this Section reflect a reasonable allocation of risk. AppealIt would not be able to offer the Service free of charge without these limitations. These limitations apply notwithstanding any failure of essential purpose of any limited remedy.

11.4 Jurisdictional limits. Some jurisdictions do not permit certain limitations of liability. In those jurisdictions, AppealIt's liability is limited to the maximum extent permitted by applicable law.

13.1 Informal resolution. Before initiating formal proceedings, you agree to contact AppealIt at [email protected] and attempt in good faith to resolve any dispute informally for at least thirty (30) days.

13.2 Binding arbitration. If informal resolution fails, any dispute, claim, or controversy arising out of or relating to these Terms or the Service -- including disputes about the formation, interpretation, breach, or enforceability of these Terms -- will be resolved by binding individual arbitration administered by the American Arbitration Association ("AAA") under its Consumer Arbitration Rules, except as provided in Section 13.5. The arbitration will be conducted in [INSERT CITY, STATE] or, if you prefer and the claim qualifies, by video conference or telephone.

13.3 Class action waiver. TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, YOU AND APPEALIT EACH WAIVE ANY RIGHT TO BRING OR PARTICIPATE IN ANY CLASS ACTION, CONSOLIDATED ACTION, OR REPRESENTATIVE PROCEEDING. The arbitrator may award relief only on an individual basis.

13.4 Arbitration costs. For claims under $10,000, AppealIt will pay all AAA filing, administration, and arbitrator fees unless the arbitrator finds your claim frivolous. For claims $10,000 or more, AAA rules govern fee allocation.

13.5 Exceptions. Either party may seek: (a) emergency injunctive or other equitable relief in any court of competent jurisdiction to prevent irreparable harm; or (b) relief in small claims court for disputes within that court's jurisdiction, without first arbitrating.

13.6 Governing law. These Terms are governed by the laws of the State of [INSERT STATE], without regard to its conflict of law provisions, except that the Federal Arbitration Act, 9 U.S.C. sections 1 et seq., governs all arbitration-related provisions.

13.7 Venue. For any matter not subject to arbitration, you consent to exclusive jurisdiction and venue in the state or federal courts located in [INSERT COUNTY, STATE].

13.8 Time limit. ANY CLAIM ARISING OUT OF OR RELATED TO THESE TERMS OR THE SERVICE MUST BE BROUGHT WITHIN ONE (1) YEAR AFTER THE CLAIM ARISES. CLAIMS NOT BROUGHT WITHIN THAT PERIOD ARE PERMANENTLY BARRED.

14.1 Free to patients. The Service is provided to patients at no charge under the current free tier. AppealIt reserves the right to introduce paid tiers, premium features, or different pricing models for non-patient users (e.g., healthcare administrators, advocacy organizations, or commercial users) in the future.

14.2 No service level guarantee. The free tier is provided without any uptime, availability, or response time guarantee. We may suspend, modify, or discontinue the Service (or any feature of it) at any time with or without notice.

14.3 Usage limits. AppealIt may impose reasonable rate limits, appeal volume caps, or other usage restrictions on free-tier accounts to maintain service quality. We will make reasonable efforts to notify you of material changes to free-tier limitations.

14.4 Scope of coverage. The current free tier supports appeal drafts for GLP-1 medication denials (e.g., semaglutide, tirzepatide) and CGRP migraine therapy denials. Support for additional denial categories may be added or removed at AppealIt's discretion.

14.5 No data portability obligation. AppealIt has no obligation to export, migrate, or retain your data if the Service is discontinued. We recommend you retain copies of all generated drafts outside the Service.

15.1 Changes to Terms. AppealIt may update these Terms at any time. Material changes will be communicated by updating the "Last Updated" date and, where feasible, by in-app notice or email. Continued use after the effective date of changes constitutes acceptance.

15.2 Service changes. AppealIt reserves the right to modify, suspend, or discontinue any aspect of the Service at any time without liability to you.

15.3 Termination by AppealIt. AppealIt may terminate or suspend your access immediately, without prior notice, for violation of these Terms, suspected fraudulent activity, or any other reason at AppealIt's sole discretion.

15.4 Effect of termination. On termination, your right to use the Service ceases. Sections 3, 4, 5, 9, 10, 11, 12, 13, and 16 survive termination.

16.1 Entire agreement. These Terms, together with our Privacy Policy, constitute the entire agreement between you and AppealIt regarding the Service and supersede all prior agreements and understandings.

16.2 Severability. If any provision of these Terms is found invalid or unenforceable, that provision will be limited to the minimum extent necessary, and the remaining provisions will remain in full force.

16.3 No waiver. AppealIt's failure to enforce any right or provision of these Terms is not a waiver of that right or provision.

16.4 Assignment. You may not assign or transfer your rights under these Terms without AppealIt's prior written consent. AppealIt may assign these Terms freely, including in connection with a merger, acquisition, or sale of assets.

16.5 Force majeure. AppealIt is not liable for delays or failures in performance resulting from causes beyond its reasonable control, including acts of God, internet outages, government actions, or third-party service failures.

16.6 Notices. Legal notices to AppealIt should be sent to [email protected] or [INSERT MAILING ADDRESS]. Notices to you will be sent to the email address associated with your account or posted within the Service.

16.7 Accessibility. If you need this document in an alternative format due to a disability, contact [email protected].