Sample of Insurance Appeal Letter for Rejected Insurance Coverage For Medical Treatment
Whenever you are dealing with insurance companies; you must do so, with as much details and paperwork as possible. There are times when insurance companies will simply delay or reject coverage, based on terms and conditions, which hardly anyone reads. If possible send the letter from a lawyer or a third party who acts on your behalf. This letter is written to be sent to insurance company for a coverage that was denied for a medical treatment.
Start the letter off by date, name of the insurance company and their address. Make sure to also add policyholders name, type of coverage and the patient’s policy number. As a third party, state the name of the patient and your reason for writing the letter. If you are writing your own letter by using this sample, add your own treatment in place for Braces for his teeth. Update the dates with the days that apply to you. Add the name of your doctor and list why the initial coverage was denied. Once again it is imperative you supply as much details and third party letters from your doctors along with the contact details. Insurance company most likely will call to confirm.
Sample of Insurance Appeal Letter for Rejected Insurance Coverage For Medical Treatment
December 26, 2013
Blair Insurance
1050 Bank Street
Ottawa, Ontario
Canada
Re: Mark Moio,
Dental Coverage,
Type of Coverage: Dental braces
Policy number: MM-3429830
Dear, Janice Mani
Please accept this letter as Mark Moio’s appeal to Blair Insurance decision to deny coverage for braces for his teeth.
From what I understand from your denial letter dated December 21, 2013 that coverage for the braces for Mark’s teeth has been denied because: your policy does not cover cosmetics.
I am sure you are aware, Mark Moio had a car accident on January 20, 2012. Currently Dr. John brown believes that Mr. Moio will significantly benefit from white braces. I have attached the letter from Dr. John Brown, which details why braces for Mr. Moio is a necessity rather than cosmetics.
Mark Moio believes that your file on him, did not contain all relevant documents during your initial review. Mr. Moio has attached a letter from Dr. Brown from Civic hospital in Ottawa who is a resident specialist for facial surgeries. His letter discusses the facial restructure procedure in more detail. Also included are the police and medical report for the accident from January 2012. You will clearly be able to see the damage done to the face and teeth.
Based on the missing information, which is now attached with this letter, Mr. Moio is requesting reconsideration on your past decision and authorize coverage for the White braces Dr. Brown outlined in his letter.
It is paramount for your reverted decision to be available as soon as possible; the initial appointment for the treatment is scheduled to begin on January 23, 2014. If you have any questions or need any further information, please contact Mr. Moio at 416-978-3456. Mr. Moio is looking forward to hearing from you in the near future.
Sincerely,
Micheal Lee
