Recourse

Recourse turns a coverage denial into a case, and the case works itself. A patient, caregiver or billing clerk drops in a denial letter as a photo, a PDF or text. Recourse reads it into a case card the user checks and corrects. Nothing runs until they confirm it. It then works out which program and policy govern the service (Florida Medicaid MMA, LTC and KidCare; Medicare Parts A, B, D and Medicare Advantage; dual-eligible cases under both, side by side), plans its own questions about the written rules, and answers each one with the rule quoted word for word from one of 64 public policy documents (2,589 pages), cited to the document and page. A verifier checks every quote against the page text; anything it cannot support is struck out on screen, not hidden. Before deciding, the agent argues the payer's side first. Then it gives one of three verdicts: the denial matches the policy, the denial appears inconsistent with the policy, or the documents do not settle it. For an inconsistent denial it drafts the appeal letter with a verified citation on every sentence, the evidence checklist the policy implies, the filing deadline with a day count, and where to file. It never gives medical advice; treatment and diagnosis questions are refused. Why it matters: KFF's analysis of 2025 prior authorization data found denials are rarely appealed, yet 67% (Medicare Advantage), 47% (Medicaid managed care) and 43% (ACA marketplace) of appealed denials were overturned. The letter, the deadline and the rule are the hard part. It was measured before it was shown. A 160-row human-verified golden set over all 64 documents; an LLM judge validated against my own grades on 50 answers (84% exact agreement, kappa 0.70); 30 reviewed synthetic denial cases run three times end to end: the verdict right on 25 to 28 of 30, 224 of 224 appeal-letter claims verified against the page, the open-weights second opinion agreeing on 79 of 84, about $0.10 and about a minute a case. Every number is in the repo. The policy corpus, the golden set and the retrieval groundwork were built before the event (the 30 denial cases during it, on the first evening) and are disclosed in the README timeline; the product was built inside the event window. Live at https://recourse-murex.vercel.app (the API on Modal). Sample letters to paste are in the repo; the landing's sample case is a recorded real run.