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claim-denial-decoder

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解读保险拒赔信——所引理由到底什么意思、是否属于常被推翻的类型，以及逐点回应的申诉信。当有人问'保险拒赔了我该怎么办'、'帮我解读这封拒赔信'、'这个拒赔能申诉吗'或'帮我写保险申诉'时使用。产出附翻案概率框架的拒赔解读、证据清单、逐点回应的申诉信，以及越过保险公司的升级阶梯。

skills-i18n/zh/claim-denial-decoder/SKILL.md

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> [claim-denial-decoder](../../../skills/claim-denial-decoder/SKILL.md) 的简体中文翻译 — 英文版本为规范版本。

# 拒赔解读技能

拒赔信写出来是为了终结对话；申诉之所以存在，是因为对话往往不该终结。相当一部分拒赔——尤其是编码错误、"非医疗必需"和材料缺失——在有人用证据而非愤怒回应*所引理由*时被推翻。这个技能解读拒赔信到底主张了什么，把每项主张配上能回应它的证据，然后写出那封读起来像出自一个会继续升级的人之手的申诉信。

## 这个技能产出什么

- 拒赔解读：所引理由的大白话版本，以及该理由类型对申诉胜算意味着什么
- 与拒赔类型匹配的证据清单——动笔前先收集什么
- 申诉信——逐点回应、逐项引用文件、紧扣期限
- 升级阶梯——内部申诉层级、外部/独立复核、监管投诉——按顺序排列

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