Draft the Medicare appeal letter
without uploading the patient's records.
Some caregivers will photograph the Medicare denial and let Health Agent do the work in the cloud. Some won't. For the second group: this is the same desk that drafts the appeal letter — but it runs on the caregiver's own Mac or Linux computer, never sees the network, and never asks for an account. The trade-off is roughly eight gigabytes of disk and enough memory to run a twelve-billion-parameter language model.
Install Ollama on a Mac or Linux computer, pull the openly-available Gemma 3 12B language model, apply the Bonis Medicare appeal letter desk file, and run it from a terminal. The desk drafts the letter for any of the five Medicare appeal levels and substitutes square-bracket placeholder tokens for personally identifiable information so the caregiver fills the values in from a paper copy at print time. The patient's records do not transit any Bonis server. Builder-grade install today; a consumer-grade installer is scheduled.
Bounded scope, hard refusals.
The desk is a single-purpose caregiver-navigation tool. It is not a general-purpose chatbot. The boundaries below are enforced inside the desk file as binding refusals.
Redetermination, reconsideration, Administrative Law Judge hearing, Medicare Appeals Council review, and federal district court. The caregiver specifies the level in the prompt. If no level is specified, the desk defaults to redetermination — the first level.
Beneficiary name, Medicare number, dates of service, denial dates, provider
names, control numbers — these are rendered as [BRACKET TOKENS] in the
letter body. The caregiver fills the values in by hand from a paper copy when
printing. Echoing the caregiver's supplied values into the body is the failure
mode; the placeholder substitution is the protection.
Diagnosis, treatment recommendation, prescription guidance, or any clinical opinion is refused. Consult a licensed clinician.
Attorney-client analysis, representation strategy, or counsel on case strategy is refused. Consult a licensed attorney familiar with Medicare appeals.
Medicaid, VA, TRICARE, ACA marketplace, private insurance, employer group health, long-term-care insurance, and Social Security Disability are all outside scope. The frameworks differ; the desk refuses these prompts.
Creative writing, history, technology, or anything unrelated to a Medicare coverage, payment, or authorization decision is refused with the verbatim refusal line.
Five levels, five different windows.
Medicare appeals are governed by the Centers for Medicare & Medicaid Services and
follow a five-level structure. Each level is heard by a different body and has its
own filing window. The desk drafts a letter for the level the caregiver specifies; it
does not adjudicate which level applies. The current deadlines and the current
minimum amount-in-controversy thresholds at higher levels are set by CMS and
published at medicare.gov — the desk renders these as [CMS-WOULD-CITE: verify on
denial notice] tags so the caregiver looks up the current value rather than
relying on a pretrained number from the model.
- Redetermination Reviewed by the Medicare Administrative Contractor (MAC) that issued the denial. Filing window: see the denial notice for the current deadline.
- Reconsideration Reviewed by a Qualified Independent Contractor (QIC), independent of the MAC. Filing window: see the redetermination decision notice for the current deadline.
- Administrative Law Judge hearing Heard by an Administrative Law Judge at the Office of Medicare Hearings and Appeals. Filing window plus a minimum amount-in-controversy threshold apply; verify the current values on cms.gov.
- Medicare Appeals Council review Reviewed by the Medicare Appeals Council within the Departmental Appeals Board. Filing window: see the ALJ decision notice for the current deadline.
- Federal district court Civil action in federal district court. Filing window plus a higher minimum amount-in-controversy threshold apply; verify the current values on cms.gov.
The desk drafts the letter. For an appeal at Administrative Law Judge level or beyond, or for any appeal involving significant amount in controversy, retain qualified counsel familiar with Medicare appeals. The desk does not provide legal advice and does not act as the beneficiary's legal representative.
Five steps, then the desk drafts the letter.
The desk is shipped today as a builder-grade install — a developer-comfortable caregiver, or a relative who is comfortable on a terminal, can set it up in roughly fifteen minutes on a recent Mac or Linux machine with enough memory to run a twelve-billion-parameter language model. A consumer-grade installer is scheduled.
- 1. Install Ollama on your computer. Ollama is the local language-model runtime. It is openly distributed; the installer is at ollama.com. macOS and Linux are supported. The runtime itself is what executes the language model; no Bonis service is involved.
-
2. Pull the openly-available Gemma 3 12B language model.
From a terminal, run
ollama pull gemma3:12b. The download is roughly eight gigabytes on disk. Gemma 3 is a Google language model distributed under the Gemma terms of use; it runs locally on your computer once pulled. -
3. Apply the Bonis Medicare appeal letter desk file.
The desk file is a short text file that bounds the model to caregiver-
navigation Medicare appeal output — it adds the placeholder-token substitution rule,
the four out-of-scope refusals, the [CMS-WOULD-CITE: ...] citation discipline, and
the verbatim-refusal line. Build the desk with
ollama create healthagent-medicare-appeal -f Modelfile-medicare-appeal. Bonis publishes the desk file separately; the build path is scheduled to be linked from this page when the consumer-grade installer ships. -
4. Run the desk with the case details.
From a terminal, run
ollama run healthagent-medicare-appeal "Draft a Level 1 redetermination request for a denial of [type of service]. Denial reason: [reason from denial notice]. Beneficiary: [name]. Date of service: [date]. Medicare number: [MBI].". The desk reads the prompt, applies the placeholder substitution to anything personally identifiable, drafts the letter, and prints the result to the terminal. -
5. Review the draft, fill the placeholders, sign, and submit.
Read the draft. Resolve every
[CMS-WOULD-CITE: ...]tag by looking up the current value on cms.gov or on the denial notice. Fill the[BRACKET TOKENS]in from a paper copy of the patient's records. Sign, date, and submit the letter to the address printed on the denial notice — the MAC address for redetermination, the QIC address for reconsideration, the Office of Medicare Hearings and Appeals for ALJ, and so on. The desk does not submit on the caregiver's behalf.
The desk does not invent regulatory citations.
The local language model has no live access to the Code of Federal Regulations, the Medicare Benefit Policy Manual, current Federal Register notices, the National Coverage Determination database, the Local Coverage Determination database, or the current dollar thresholds set annually by CMS. A pretrained model that invents specific section numbers, transmittal numbers, NCD numbers, LCD numbers, or dollar amounts is a fabrication risk on a regulated filing.
The desk file bounds this with a hard rule: every cite of a regulation, manual
section, deadline, dollar threshold, or form number is rendered as a
[CMS-WOULD-CITE: ...] tag with a general descriptor inside. For example
[CMS-WOULD-CITE: 42 CFR Part 405 Subpart I — Medicare appeals framework]
or [CMS-WOULD-CITE: current ALJ amount-in-controversy threshold — verify
Federal Register]. Specific section numbers, NCD numbers, LCD numbers, dollar
figures, and deadline-day counts are explicitly disallowed inside the tag.
The desk also produces a "CITATION TAGS USED" section at the end of the letter listing every tag in the body. The caregiver works through that list against cms.gov, the denial notice, and the appropriate primary source, and replaces each tag with the verified citation before sending.
Tamper-evidence on your own computer.
Every run of the local desk anchors an event in a local append-only hash-chain log file on the caregiver's computer. Each event holds a SHA-256 of the canonical-JSON payload, a link to the previous event's full-record SHA-256, and an ISO-8601 timestamp. A chain-verify routine walks the log line by line and recomputes every hash link. If a record is altered after the fact, the chain breaks at the altered link and the verify routine fails. That is tamper-evidence on the caregiver's own hardware — a personal audit trail of every desk run.
The local hash chain is not the same as the cloud Health Agent Knox chain. On the cloud product, the chain is rolled into a Merkle tree and submitted to the Bitcoin blockchain via OpenTimestamps for independent third-party verifiability. Bitcoin anchoring of the local chain is not wired by default; it is a separate workflow that a caregiver can opt into if they want a public-verifiable timestamp on the local chain tip.
Knox is the Bonis cryptographic audit-permanence primitive. USPTO provisional 64/038,359. Bonis provides tamper-evidence, not tamper-prevention — the chain detects alteration after the fact; it does not prevent it.
Every state has a free Medicare counselor — use them.
The State Health Insurance Assistance Program — SHIP — is a national network of state-administered programs that offer free, unbiased, one-on-one Medicare counseling to beneficiaries and family caregivers. SHIP counselors can review a denial notice, explain which appeal level applies, help with filing, and answer questions about Medicare Advantage and Part D plans. SHIP is authorized under 42 U.S.C. § 1395b-4 and funded through grants from the federal Administration for Community Living; counseling is provided to the beneficiary at no cost regardless of income.
The federal program page is at acl.gov, and the national locator that maps to the local SHIP office in each state is at shiphelp.org. If the appeal involves complex legal questions or significant amount in controversy, consult a licensed attorney or a SHIP counselor before sending the letter the desk drafts.
Common questions from caregivers.
How is this different from the cloud appeal generator at /medicare-appeals.html?
The cloud appeal generator runs in a Health Agent account on Bonis servers. The patient's denial letter and record extracts move to a cloud workspace. The local desk on this page runs entirely on the caregiver's own computer using an openly- available language model. No account is required. The denial letter and the patient's record do not leave the caregiver's hardware. The trade-off: the local desk requires the caregiver to install Ollama and pull a roughly eight-gigabyte language model. For a caregiver without that comfort, the cloud generator is the faster path.
What hardware does the local desk need?
A recent Mac (Apple Silicon strongly preferred) or a recent Linux machine with enough memory to run a twelve-billion-parameter language model — sixteen gigabytes of unified memory on Apple Silicon is workable; thirty-two gigabytes is comfortable. Roughly eight gigabytes of disk for the language model file. No GPU is strictly required on Apple Silicon; on Linux a recent NVIDIA GPU makes runs much faster but is not strictly required.
Does the desk echo the patient's personally identifiable information back into the letter?
No. The desk substitutes square-bracket placeholder tokens — [BENEFICIARY
NAME], [MEDICARE NUMBER / MBI], [DATE OF SERVICE],
[DENIAL DATE], [PROVIDER NAME], and similar — for any
personally identifiable information the caregiver supplies in the prompt. The body
of the letter contains only the placeholder tokens; the caregiver fills the values
in by hand from a paper copy when printing. The presence of personally identifiable
information in the prompt is not a refusal trigger.
Does the desk cite specific regulations and dollar thresholds as facts?
No. Any cite of a regulation, manual section, deadline, dollar threshold, or form
number is rendered as a [CMS-WOULD-CITE: ...] tag with a general
descriptor inside. The caregiver resolves each tag against cms.gov and the denial
notice before sending. The desk does not invent specific section numbers,
transmittal numbers, NCD numbers, LCD numbers, or dollar amounts.
What does the local hash chain do?
The desk anchors each run in a local append-only hash-chain log file on the caregiver's computer. Each entry is SHA-256-linked to the previous entry. A chain-verify routine walks the log and confirms every link is intact; alteration of any record breaks the chain at that link. That is tamper-evidence on the caregiver's own machine. It is not the same as the cloud Health Agent Knox chain, which is rolled into a Merkle tree and submitted to the Bitcoin blockchain via OpenTimestamps on the cloud product. Bonis provides tamper-evidence, not tamper-prevention.
Is the desk endorsed by Medicare or CMS?
No. The desk is published by Bonis Systems LLC, an independent Wyoming-registered firm. There is no endorsement, affiliation, or partnership with the Centers for Medicare & Medicaid Services, the Social Security Administration, or any Medicare Administrative Contractor.
Does the desk give legal advice?
No. The desk drafts a caregiver-navigation letter. It is not a law firm, does not employ attorneys, and does not provide legal advice. For an appeal at Administrative Law Judge level or beyond, retain qualified counsel familiar with Medicare appeals, or consult a SHIP counselor at no cost.
The desk is real. The installer is the next ship.
The local Medicare appeal letter desk runs today on the author's own machines and on every developer-comfortable caregiver's machine that has installed Ollama and pulled the desk file. A consumer-grade installer — a single download for a non-developer caregiver — is on the build queue. When that ships, this page will link the download here. For a caregiver who needs the same outcome today without a terminal install, the cloud path is at /medicare-appeals.html.