Helping Patients Access the Care They Need

Because we configure our platform to each client’s needs, the use-case for each client can vary. Some other examples of our use-cases include:

  • Using AI to assess a patient’s case for prior auth and appeal submission-readiness, and automatically generating customized prior auth and appeal letters

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  • Setting up the patient access program for Cooler Heads

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  • Generating appeals for an innovative sleep apnea surgery

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These are just a few potential use-cases, our tool can be used by patient access teams, providers, and/or patients. We build the platform to your specific needs.

01

Company Background

Paxos was founded on a personal mission. Two of its co-founders, Alex and Malcolm, were each denied coverage for medically necessary, but expensive, surgeries. Despite multiple appeals from their providers, insurers refused to budge. Left with few options, they researched, strategized, and fought back themselves, and won. Along the way, they uncovered just how stacked the system was against patients who lacked the time, expertise, or stamina to push back. Their experience inspired Paxos: a company built to help others navigate that same uphill battle, with more support, better tools, and a dramatically higher chance of success.

02

The Challenge

  • Every year, millions of patients are denied insurance coverage for treatments they need—treatments that are often backed by sound clinical evidence but blocked due to technicalities, coding errors, or incomplete documentation. While providers may attempt to appeal, they have limited resources, and cannot continue to fight insurers all day. In fact:

    Fewer than 1% of denied patients file their own appeal, yet 40% of appeals are successful when patients do push forward.1

  • That gap represented a huge opportunity. Patients needed a clear, credible way to take matters into their own hands, especially when their health and finances were on the line.

“Paxos Appeals truly came to our rescue! Their team was not only compassionate and insightful but also incredibly efficient and proactive in helping us navigate a previously frustrating, disorienting and unjust insurance denial.”
Bruno R
“Paxos Appeals was amazing! They reviewed my case and gave me specific points to add to my 2nd level appeal in the language of medical coding. Because of them, I was able to get my medical procedure fully covered by insurance! Genuinely nice and helpful people. I can't thank them enough.”
Andrew C.
“Paxos Appeals was a lifesaver for me after experiencing multiple insurance denials for a jaw surgery procedure. I was left with my only option being to write and submit my own appeal, which I had no idea where to even begin with. The team at Paxos Appeals is extremely knowledgeable when it comes to insurance- not only do they offer an amazing service to have an appeal written specifically for you, but they also stick with you for every step of the process to answer whatever questions may arise.”
Christine D. 
“I can't say enough good things about Paxos Appeals! When we were hit with a denial, we felt completely lost. But their team stepped in with such kindness and clarity, turning everything around in no time. They were quick to act and incredibly knowledgeable, making the whole process so much smoother. I'm beyond thankful for their help and would recommend them to anyone without a second thought.”
Luan T. 
“Paxos Appeals truly came to our rescue! Their team was not only compassionate and insightful but also incredibly efficient and proactive in helping us navigate a previously frustrating, disorienting and unjust insurance denial.”
Bruno R
More reviews

03

Why Patients Chose Paxos

  • Unlike large vendors offering generic, automated tools, Paxos took a hands-on approach:

    Patients worked directly with real reimbursement experts, not call centers

    Each appeal was custom-built, anchored to payer policies and clinical data

    Paxos helped patients not only write their appeals, but also submit them to the right contacts, with the right forms and documentation

    Pricing was higher than off-the-shelf template services, patients got a premium, white-glove experience and meaningful results.

  • This combination of strategy, service, and credibility led patients to choose Paxos when it mattered most.

Our Solution

Synthesizes medical information with AI to generate prior auths, appeals, and other patient-specific documents
Transforms your team into case reviewers rather than writers by enabling AI-assisted double-checking of all outputs
Integrates payer-specific policies, diagnosis-specific guidelines, clinical literature, and product evidence
Delivers up-to-date reimbursement trend data for your device to support payer negotiations and provider sales

How Paxos Helped

Paxos supported patients from start to finish—building strong medical necessity arguments and identifying the most strategic routes for appeal.

01

Reduced operations costs

We streamline reimbursement workflows and empower your case writers to become case reviewers who can focus their expertise on the things that matter, not cumbersome documentation tasks.

Increased product adoption

We aim to drive higher payer approvals and broader coverage, building provider confidence to utilize your innovative technology.

02

03

Enhanced reimbursement insights

Our data equips patient access teams to better navigate payer negotiations and improve their provider sales process.

Policy + Plan Analysis
Parsed each patient's specific insurance policy to determine the best legal and clinical argument—be it medical necessity, network gap, or experimental procedure rebuttal
End-to-End Support
 From intake to final submission, Paxos helped patients understand their options, collect supporting documentation, and escalate to the appropriate reviewer
Custom Letter Generation
Created highly tailored appeal letters that referenced not just clinical evidence, but insurer language and local coverage determinations
Direct Insurer Engagement
Where possible, Paxos provided guidance on peer-to-peer review, second-level appeals, or external review escalation

$2.5M+ in coverage secured for patients

90%+ success rate in overturning denials

Appeals spanned surgical specialties from orthopedics to reproductive health

Patients often got care approved when all other efforts had failed

Whether facing denied surgeries, out-of-network barriers, or policy misinterpretations, Paxos gave patients the power to fight back—and win. With premium, case-specific support and unmatched success rates, Paxos proved that patients don’t need to accept “no” as the final answer.

Watch Our Keynote

  • Kaiser Family Foundation, Claims Denials and Appeals in ACA Marketplace Plans in 2023, available at kff.org.

Testimonials

Paxos' expertise and tailored reimbursement tools are streamlining our ability to get devices to patients, producing reliable and policy-focused documents without requiring us to hire additional staff. Their offering is also increasing utilization of our product with payers, which will help with achieving broader payer coverage.

Interested in our solution?

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