Sample of a Health Insurance Appeal Letter
Health insurance appeal letter is written by a patient or someone on his or her behalf, to the insurance company or its representative after they have denied a heath claim.
This letter is quite simple. Simply write all necessary details and keep your tone professional and formal.
Sample of a Health Insurance Appeal Letter
Feb 12, 2013
Joe Saint
24th Bond Street
Chicago City, 2345
Instep Health Insurance
Narrow Street, Burton
Chicago
Re: Patient: Adam Saint
Policy ID: 34321-C
Treatment dates: January 12, 2013 to January 18 2013
Total charges: $ 3450
Dear Ms. Jessica,
I am writing in response to your denial of my father, Adam Saint’s recent medical claim on grounds that the application did not have the requisite clearance from your designated physician, Mr. Isaac, within the due time frame – the first week of February.
However, I feel that the denial is not justified as the health plan does not provide adequate information to establish the validity of your decision. Before the initial review from your department, the patient did not have the necessary medical documents, but enclosed the claims with a letter, which clearly stated that Mr. Isaac’s approval could not be acquired, since he was not in town.
Since my father’s condition was critical, he had to continue with the treatment in consultation with another physician, Mr. John Chase (receipts attached with this letter). However, I kept Mr. Isaac informed about the whole procedure and provided Mr. John Chase’s details, who treated my father in his absence. Unfortunately, your insurance department, which I contact earlier, denied my father’s claim since Mr. John Chase is not a doctor endorsed by your company.
Since Mr. Isaac is back in town, I visited him and got his approval on my father’s medical treatment, which is enclosed with this letter. I believe this should suffice, since the coverage plan states that a physician, recommended by a doctor endorsed by you, can treat a patient within his medical coverage. Based on the information provided, please reconsider your decision and approve my father’s insurance claim. If still you need any clarification, feel free to contact me on the following telephone number or email address.
Phone Number: xxxxxxxxxxxx
Email id: xxxxxx
Waiting anxiously for your response,
Yours Sincerely,
Joe Saint.
