Terms of Service

1. Acceptance of Terms

By accessing or using ClearCost Appeals ("the Service"), operated by ClearCost Appeals ("we," "us," or "our"), you agree to be bound by these Terms of Service ("Terms"). If you do not agree to these Terms, you may not use the Service. We reserve the right to update these Terms at any time, and your continued use of the Service after any such changes constitutes acceptance of the revised Terms.

2. Description of Service

ClearCost Appeals is an informational tool that generates documents to assist users in appealing insurance claim denials. The Service uses artificial intelligence (specifically, Anthropic's Claude language model) to analyze denial details provided by users, research relevant clinical evidence from PubMed (the National Library of Medicine's database), and generate appeal letters, letters of medical necessity, external review requests, and related documents.

The Service is designed to help users understand and exercise their existing rights under federal and state law to appeal insurance denials. It does not create new legal rights, nor does it guarantee any particular outcome.

3. Not Legal or Medical Advice

Specifically:

• Not legal advice: The Service does not establish an attorney-client relationship. The information and documents provided are not a substitute for the advice of a qualified attorney. If your case involves complex legal questions, ERISA litigation, or significant financial stakes, you should consult with a licensed attorney in your jurisdiction.
• Not medical advice: The Service does not diagnose, treat, or provide medical opinions. Clinical information included in generated documents is drawn from published medical literature and is intended to support your appeal, not to guide treatment decisions. Always consult your treating physician for medical advice.
• Not a substitute for professional judgment: Generated documents are drafts. They require your review and, where applicable, review by your treating physician before submission to your insurer.

4. User Responsibilities

When using the Service, you agree to the following:

• Accuracy of information: You are solely responsible for the accuracy, completeness, and truthfulness of all information you provide to the Service, including patient information, denial details, clinical history, and insurance information. Inaccurate input will produce inaccurate output.
• Review before submission: You must carefully review all documents generated by the Service before submitting them to your insurer, a state agency, or any other party. You are responsible for verifying that the content is accurate, appropriate for your situation, and consistent with your medical records.
• Clinical citations: The Service retrieves citations from PubMed and includes them in generated documents. While we verify that cited PubMed IDs (PMIDs) exist and correspond to real publications, you should confirm that the cited studies are relevant to your specific clinical situation and that the characterizations of those studies are accurate.
• Compliance with laws: You agree to use the Service only for lawful purposes and in compliance with all applicable federal, state, and local laws and regulations.
• No misrepresentation: You agree not to submit documents generated by the Service as if they were written by a physician, attorney, or other professional, unless such a professional has reviewed, approved, and signed the document.

5. AI-Generated Content

You acknowledge and agree that:

• The Service uses artificial intelligence (Anthropic's Claude) to generate content. AI-generated content may contain errors, inaccuracies, omissions, or hallucinations.
• AI models can produce output that appears authoritative but is factually incorrect. While we have implemented safeguards, including PubMed citation verification and structured prompting, no AI system is infallible.
• The quality and accuracy of generated documents depends in significant part on the quality and completeness of the information you provide.
• Generated documents represent a starting point for your appeal, not a finished product. Professional review is recommended.

6. No Guarantee of Outcome

The Service makes no guarantee, representation, or warranty that any appeal generated using the Service will be successful. Insurance appeal outcomes depend on many factors outside our control, including but not limited to:

• The specific terms of your insurance policy
• The clinical facts of your case
• The insurer's internal review processes and personnel
• Applicable federal and state law
• The completeness and accuracy of your medical records
• Whether supporting documentation (such as a signed Letter of Medical Necessity from your physician) is included

Past appeal success rates displayed on the Service, whether drawn from published data or from user-reported outcomes, are statistical aggregates and do not predict the outcome of any individual appeal.

7. Protected Health Information (PHI)

To generate appeal documents, the Service necessarily processes information that may constitute protected health information under HIPAA and state health privacy laws. By using the Service, you acknowledge and agree that:

• We use the information you provide solely for the purpose of generating the documents you request and for improving the Service through anonymized, de-identified aggregate statistics.
• We do not sell your personal or health information to third parties.
• We do not use your health information for advertising, marketing, or any purpose unrelated to the Service.
• Your information is transmitted to Anthropic's Claude API for processing. Anthropic's data handling practices are governed by Anthropic's terms of service and privacy policy.
• Your denial information may be used to query PubMed (operated by the National Center for Biotechnology Information, a division of the National Library of Medicine at the National Institutes of Health) for relevant clinical evidence. These queries use clinical terms related to your condition and treatment, not personally identifying information.

For more detail on data handling, please see our Privacy Policy.

8. Limitation of Liability

To the maximum extent permitted by applicable law:

• The Service, its owners, operators, employees, agents, and affiliates shall not be liable for any indirect, incidental, special, consequential, or punitive damages, including but not limited to loss of profits, data, use, goodwill, or other intangible losses, resulting from your use of or inability to use the Service.
• The Service shall not be liable for any damages arising from the denial of an insurance appeal, whether or not documents generated by the Service were used in that appeal.
• The Service shall not be liable for any errors, inaccuracies, or omissions in AI-generated content, including incorrect clinical citations, mischaracterizations of medical literature, or misstatements of law or policy.
• In no event shall our total liability to you for all claims arising out of or related to your use of the Service exceed the amount you paid to us, if any, in the twelve (12) months preceding the claim.

9. Indemnification

You agree to indemnify, defend, and hold harmless ClearCost Appeals, its owners, operators, employees, agents, and affiliates from and against any and all claims, damages, obligations, losses, liabilities, costs, or debt, and expenses (including reasonable attorneys' fees) arising from:

• Your use of the Service
• Your submission of documents generated by the Service to any insurer, government agency, court, or other party
• Your violation of these Terms
• Your violation of any applicable law or regulation
• Any inaccuracy in the information you provided to the Service

10. Disclaimer of Warranties

We expressly disclaim all warranties, including but not limited to implied warranties of merchantability, fitness for a particular purpose, non-infringement, and any warranties arising from course of dealing or usage of trade. We do not warrant that:

• The Service will be uninterrupted, timely, secure, or error-free
• The results obtained from the Service will be accurate, reliable, or complete
• Any errors in the Service will be corrected
• The Service will meet your specific requirements or expectations

11. Intellectual Property

The Service, including its design, code, content, and branding, is the intellectual property of ClearCost Appeals and is protected by applicable intellectual property laws. You may not copy, modify, distribute, sell, or lease any part of the Service without our prior written consent.

Documents generated by the Service for your use are provided to you for your personal use in connection with your insurance appeal. You retain ownership of the factual information you provide to the Service. You may use, modify, and submit the generated documents as you see fit in connection with your appeal.

12. Prohibited Uses

You agree not to use the Service to:

• Generate fraudulent or materially false appeal documents
• Submit appeals for claims you know to be invalid or not covered
• Impersonate a physician, attorney, or other licensed professional
• Interfere with or disrupt the Service or its infrastructure
• Attempt to gain unauthorized access to any portion of the Service
• Use the Service for any purpose that violates applicable law

13. Modification of Terms

We reserve the right to modify these Terms at any time. When we make material changes, we will update the "Last updated" date at the top of this page. Your continued use of the Service after any modification constitutes your acceptance of the modified Terms. If you do not agree to the modified Terms, you must discontinue use of the Service.

14. Termination

We may suspend or terminate your access to the Service at any time, with or without cause, and with or without notice. Upon termination, your right to use the Service will immediately cease. Sections 3, 8, 9, 10, and 15 shall survive termination.

15. Governing Law and Dispute Resolution

These Terms shall be governed by and construed in accordance with the laws of the State of Delaware, without regard to its conflict of law provisions. Any dispute arising out of or relating to these Terms or the Service shall be resolved exclusively in the state or federal courts located in the State of Delaware, and you consent to the personal jurisdiction of such courts.

Before filing any legal action, you agree to attempt to resolve any dispute informally by contacting us at the address provided below. If a dispute is not resolved within thirty (30) days of the informal complaint, either party may proceed with formal legal action.

16. Severability

If any provision of these Terms is found to be unenforceable or invalid by a court of competent jurisdiction, that provision shall be limited or eliminated to the minimum extent necessary so that these Terms shall otherwise remain in full force and effect.

17. Contact Information

If you have questions about these Terms, please contact us at:

ClearCost Appeals
Email: legal@clearcostappeals.com