Sample Letter of Appeal to Health Insurance Company

How to Write a Letter of Appeal to Health Insurance Company (With Free Samples)

When you get a letter of denial for your health insurance claim by your insurer, you need to get it review by writing back to them. This denial first can be an error by the insurance or can be the true situation of things but whatever it is you shouldn’t be intimidated. You just have to furnish them with the right information with your appeal letter and this is where you employ the appeal letter to Health Insurance Company.

So therefore, an appeal letter of appeal to Health Insurance Company is a letter of appeal that details the counter-argument of the insured which aid in addressing the original reason for denial by the insurer. With this letter the policy that gives the insured a room for such claims will be cited. This letter can also be written by the insured medical provider or advocate.

To present a well written appeal to Health Insurance Company will need you outlining the right elements that need to be seen in a health insurance appeal letter. So as such you need to use the right format. The below guidelines are what would be follow to get it right:

  • Start by stating the patient name, the policy number and the policy holder.
  • Then write the accurate contact information for the holder and the patient.
  • State the date of the denial letter, pinpoint what was denied and state the reason for denial.
  • Write the medical and doctor’s name plus the contact information.
  • You can get the letter of medical necessity explaining the before treatments.
  • Write the reason for the prescribed medical service; don’t forget to state why you believe that the policy should cover your needed treatment.
  • Then submit your letter and make sure to track it to be sure the appropriate office received it.

Below are the sample letters of appeal to Health Insurance Company

Sample 1

Breda Williams

Bedrenk insurance company

5678 Oakwood Avenue

Los Angeles, CA

 

Re: Carol Linus

Health insurance policy

Policy number: 6789

Dear Williams

This letter is coming your way as carol Linus appeal to Bedrenk insurance company decision to deny coverage for the appendix surgery procedure. It is based on my understanding of your denial letter that arrived on Tuesday this week that you have denied this procedure because your insurance policy doesn’t covered such procedure.

As already stated in the first claim letter, carol Linus was diagnosed to have appendix on 12th April. So presently the Dr. believes that Linus will greatly benefit from this surgery. Please see the enclosed medical letter from Dr. Paul of Medics villa which discusses the patient’s medical history in full. Carol  Linus thinks that you didn’t have the required information as when the initial review was carried out . This is why she has now enclosed with this appeal letter for your verification a medical letter from Dr. Paul of medics Villa.

Dr. Paul is a specialist in medics Villa, Texas, his letter discusses the procedure needed to be carried out in full. you would also be presented with the medical records as well as other journal articles that will help in explaining the results and the procedure. So with this information Carol Linus is requesting that you reconsider the former decision and give the coverage for the surgery of Dr .Paul as stated in this letter. The surgery is scheduled to be carried out at the end of this month. So if you need further explanation on this, don’t hesitate to reach me on 444-879-435 or the patient on 678-543-231. Will be looking forward to hearing from you later.

Yours sincerely,

Bar. Smith Banks

Solicitor

 

Sample 2

1st June, 2021

Felix Duke

Downtown insurance company

4356 Mayne Avenue, TX2345

 

Re: Maureen King

Health insurance policy

Policy number: 5678

Dear Duke,

As an insured of Downtown insurance company, this letter is reaching you as an appeal for you to reconsider my plea and rethink your decision on denying me the coverage for eye reconstruction procedure. I understood from your letter that I got on the 22nd that my claim letter was denied which will put a total hold on this procedure because I didn’t file the doctor’s report as I should.

I have undergone the initial assessment and have taken some treatment before now which you had helped me to achieved but to not much improvement. However, my able Doctor, Dr Peace thinks that the best procedure that will honestly help me at this point will be the reconstruction procedure. At this time there’s no physician that can carried out the procedure within the public health facility, so I have booked an appointment with a private physician which will cost a lot. This is why there’s need for me to seek the help of my health insurance company.

Attached to this appeal letter is a letter from Dr. Peace addressing why she has recommended the reconstruction procedure for me. Enclosed also is another letter from Dr. Peace that explains in full her experience and qualifications and of course diverse articles that will explain this procedure to you in full. So based on all these information I plead that you review your decision and help give the coverage that will help me undergo this procedure. The procedure will be starting on the 2nd week of July. So if you would need extra information on this, please do call me on 657-876-435 and email me at maurkin@yahoo.com. I will appreciate if you reconsider your stance to help me get the needed procedure.

Yours sincerely,

Maureen king

Conclusion

If you are denied health insurance coverage then you would fare better if you appeal such so that the insurance company can reconsider your claims. This is where you would need to write concise and clear appeal letter. This will help you to counter argument their decision. So the writing tips up there should be your guide to get your appeal letter right. You can use the sample letters as your templates to write perfectly your letter too.

LEAVE A REPLY

Please enter your comment!
Please enter your name here