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Sample
Health Insurance Appeal Letter
Instructions Click
here to order an appeal letter from Health Symphony
Your name and address
Date
Address of Claims review
department
RE: Name of Insured:
Plan ID #:
Claim #:
Dear Claims
Review Department:
[Describe
the charges you are appealing, including the date of service and
provider/facility name. Explain that you are appealing this charge
because it was denied and briefly state the denial.]
[Your
first argument goes here, explaining your initial reason why you believe
the denial was performed in error and your argument as to why it should be
overturned and claim paid. For example, was the denial not listed
in your policy booklet or did your health plan give you an
authorization approving the service?]
[Your
second argument should go here, explaining for instance that your medical
service was medically necessary or you were not advised that a denial
would occur and you should not be held liable.]
[Your
final statement should go here, describing again what you are requesting,
such as you are asking the health plan to reconsider the denial and pay
the claim in full. Thank the health plan for its consideration of
this letter].
Sincerely,
[Insured
Name]
[Add
enclosures, such as statement of medical necessity or medical records if
required]
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