A medical appeal letter is used to let your insurance company know that you would like to have your case reviewed and reconsidered. When you hand in a claim to a medical insurance company or request that a medical expense be paid for by your insurance company, this request or claim can be denied. When this happens, you will need to write a medical appeal letter and submit it to your insurance company. The better your letter, the higher your chances of getting your claim or request accepted.
Request a separate letter from your doctor which backs up the information you included in the appeal letter. This should be included with the medical appeal letter, along with relevant medical records and medical articles that backup your case.
Include the date at the very top of the medical appeal letter. Below that, include the insurance company name and contact information.
Add all of your identifying medical information below the insurance company's information. This includes your full name, date of birth, policy number, group number, claim number and contact information.
Address the medical appeal letter to a specific contact within the insurance company when possible.
Explain right away that you are appealing a decision made by the insurance company. Briefly state the insurance companies reason, along with the date you submitted the request and the date it was denied.
State your diagnosis, the date of diagnoses and the doctor's name that made the diagnosis in the next paragraph. Explain that the treating physician has recommended the treatment that was denied by the insurance company and reference the doctor's letter that you have included.
Tell the insurance company again that you do not agree with the decision to deny your request and list any supporting information you have included with the letter.
Explain in the last paragraph once more that your doctor has recommended the treatment or procedure and when it is scheduled to begin. Tell the insurance company that you can be contacted for further questioning and include your phone number and e-mail address. Sign the letter professionally.
If a case manager at a hospital or clinic is handling the appeal process on your behalf, you should get copies of all correspondence with and from the insurance company.
Tips and warnings
- If a case manager at a hospital or clinic is handling the appeal process on your behalf, you should get copies of all correspondence with and from the insurance company.