If your claim for medical insurance has been denied by the insurance company, then you would want to learn to draft an appeal letter. We will tell you how to do the same, in this article.
You never know when calamity can hit you and it is for such situations that most of us have insurance. But, what do you do if your insurance company denies your claim? In such a case, it is extremely important that you be able to draft a good appeal letter to be sent to the insurance company so that you can save on the costs that you will incur. In this article, we will tell you how to write a good appeal letter so that you do not get stuck in a fix.
Writing an Appeal Letter
Before you actually sit down to write an appeal letter, you need to first read the denial letter that you have been sent by the insurance company. Once you are aware of the actual reason for the denial of coverage, you will be in a better place to draft a letter. Always call up the insurance company first to get a detailed explanation regarding the situation. Ensure that you mention that you intend to appeal against the decision and take into account what they say. You will need to meet your doctor and probably a specialist who will be able to supply you with letters regarding your condition and give an explanation in medical terms, which can help your case with the insurance company. Always mention your coverage plan and policy number in your letter. While writing an appeal letter, you need to understand the proper format of the letter and the template given below will help you understand that.
| Appeal Letter Format |
| Name of Letter Writer Address of Letter Writer Date Name of Insurance Company Subject: Mention in brief the reason for writing the letter and include the coverage type and the policy number. To Whomsoever it May Concern/ Dear (Name of Addressee) In the first paragraph, you will need to mention why you are writing the letter, which in this case would be to appeal against the insurance company’s decision to deny coverage for the procedure that the patient has to undergo. You will also need to make a mention of the reason that you have been given for the denial of the coverage by the company, as it has been stated in the denial letter sent by them. In the next paragraph, you need to give a complete description of the disease that the patient is suffering from. Mention the name of the doctor who is treating the patient and mention the name of the procedure that has been advised by the doctor. Try and send out a letter from the doctor which discusses not only the medical history of the patient but also talks about the benefits of the said procedure. Mention how you believe that the insurance company did not have the requisite information earlier in order to make a decision that took every aspect into consideration. If there are any specialist doctors who have looked at the case, then mention this and include a supporting letter from the doctor. In the third and final paragraph, mention how you think that in the light of the information that has been presented, the company should review the previous decision that they have made and allow for coverage for the procedure that needs to be undertaken. Mention your contact details and include a line on how you are waiting to hear from the company. Thanking you, Yours sincerely, Name of Letter Writer |
So, now you know what are the points that need to be included in an appeal letter and how you need to format such a letter. If your appeal is not responded to or turned down again, you can request for an additional appeal and in case there is still no response or change, you can contact the state insurance commissioner who should be able to help you with your case.
