Sample Appeal Letter For Health Claim - Free Download
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Sample Appeal Letter For Health Claim
Sample Appeal Letter For Health Claim
18 part series
Financial Literacy 2007
Sample appeal letter for health claim
Sample appeal letter for health claim
Use this letter as a guideline when appealing a health insurance claim denial. In order for the
letter to be effective, you should personalize it by putting it into your own words.
Rewrite the letter, inserting your personal information in the areas indicated in red. You can
print out this PDF and make your changes by hand or copy the body of the letter and paste it
into a document where you can make your changes on your PC.
Form letter for denial of specific medical procedure
Date
Name
Insurance Company name
Address
City, State and ZIP Code
Re: Patient’s name
Type of coverage
Group number/Policy number
Dear Name of contact person at insurance company,
Please accept this letter as patient's name appeal to insurance company name decision to
deny coverage for state the name of the specific procedure denied. It is my understanding
based on your letter of denial dated insert date that this procedure has been denied because:
Quote the specific reason for the denial stated in denial letter.
As you know, patient's name was diagnosed with disease on date. Currently Dr. name
believes that patient's name will significantly benefit from state procedure name. Please see
the enclosed letter from Dr. name that discusses patient's name medical history in more
detail.
Patient's name believes that you did not have all the necessary information at the time of
your initial review. Patient's name has also included with this letter, a letter from Dr. name
from name of treating facility. Dr. name is a specialist in name of specialty. His/Her letter
discusses the procedure in more detail. Also included are medical records and several journal
articles explaining the procedure and the results.
Based on this information, patient's name is asking that you reconsider your previous
decision and allow coverage for the procedure Dr. name outlines in his letter. The treatment
is scheduled to begin on date. Should you require additional information, please do not
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