Medical Bill Appeal

Your insurer denied the claim. Now what?

Medical Bill Appeal is an OpenClaw skill that reads your Explanation of Benefits, identifies the denial code, and drafts a complete internal appeal letter — with the federal regulation citations the insurer's appeals team actually has to respond to. Most denial letters are designed to make you give up. This skill gives you the language and the legal framework to push back.

What it does

• Parses a plain-text EOB or medical bill and extracts denial codes (CARC/RARC), billed amounts, allowed amounts, and CPT line items
• Looks up the strongest appeal angle for 25+ denial codes — medical necessity, prior authorization, non-covered services, ACA preventive service violations, and more
• Drafts a complete internal appeal letter citing ERISA § 503, 45 CFR § 147.136, and the specific ACA or state provision that applies to your denial
• Tracks open appeals with deadlines: 180-day internal appeal window, 60-day external review window, with urgent flags for claims within 30 days

What's in the package

All files listed below are bundled as fenced code blocks inside SKILL.md — there's no separate folder to install. Copy each code block into its own file using the path shown above it.

• SKILL.md — the full workflow your agent follows, including when to call first vs. write a formal letter.
• scripts/parse_eob.py — extracts structured data (denial codes, amounts, CPT codes) from a pasted or saved EOB text file.
• scripts/draft_appeal.py — produces a complete, citation-ready internal appeal letter based on the parsed EOB and your member details.
• scripts/track_appeal.py — maintains a JSON log of open appeals with deadlines and contact history. Commands: add, update, show, deadlines.
• data/denial-code-handbook.yaml — maps 25+ CARC/RARC denial codes to plain-language descriptions, the best appeal angle per code, required documents, and the exact regulation to cite. Also includes external review guidance and a strategy section on peer-to-peer review.
• scripts/examples/ — sample EOB, parsed JSON output, and a complete sample appeal letter so you can verify the workflow before using it on a real claim.

How it ships

Drop SKILL.md into ~/.openclaw/skills/medical-bill-appeal/. Restart OpenClaw. Run /medical-bill-appeal or describe what you need — your agent picks it up.

Questions: hackedcubeapps@gmail.com (response within 48 hours).